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Kurisu K, Inada S, Maeda I, Nobata H, Ogawa A, Iwase S, Uchida M, Akechi T, Amano K, Nakajima N, Morita T, Sumitani M, Yoshiuchi K. Effectiveness of antipsychotics for managing agitated delirium in patients with advanced cancer: a secondary analysis of a multicenter prospective observational study in Japan (Phase-R). Support Care Cancer 2024; 32:147. [PMID: 38326487 PMCID: PMC10850172 DOI: 10.1007/s00520-024-08352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition. METHODS We conducted a secondary analysis of a multicenter prospective observational study in Japan. The analysis included patients with advanced cancer who presented with agitated delirium and received pharmacotherapy. Agitation was defined as a score of the Richmond Agitation-Sedation Scale for palliative care (RASS-PAL) of ≥ 1. The outcome was defined as -2 ≤ RASS-PAL ≤ 0 at 72 h after the initiation of pharmacotherapy. Multiple propensity scores were quantified using a multinomial logistic regression model, and adjusted odds ratios (ORs) were calculated for haloperidol, chlorpromazine, olanzapine, quetiapine, and risperidone. RESULTS The analysis included 271 patients with agitated delirium, and 87 (32%) showed -2 ≤ RASS-PAL ≤ 0 on day 3. The propensity score-adjusted OR of olanzapine was statistically significant (OR, 2.91; 95% confidence interval, 1.12 to 7.80; P = 0.030). CONCLUSIONS The findings suggest that olanzapine may effectively improve delirium agitation in patients with advanced cancer.
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Affiliation(s)
- Ken Kurisu
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Inada
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Psychosomatic Medicine, Saitama Cancer Center, Saitama, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | | | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Osaka, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, Okinawa, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
- Research Association for Community Health, Hamamatsu, Shizuoka, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Ohinata H, Aoyama M, Hiratsuka Y, Mori M, Kikuchi A, Tsukuura H, Matsuda Y, Suzuki K, Kohara H, Maeda I, Morita T, Miyashita M. Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions. BMJ Support Palliat Care 2024; 13:e1174-e1180. [PMID: 36302613 DOI: 10.1136/spcare-2022-003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer. METHODS This study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of Illness, physical function and the Integrated Palliative care Outcome Scale. We used multinomial logistic regression to analyse ORs for factors associated with Phase of Illness. Twenty-three palliative care units in Japan participated from January 2017 to September 2018. RESULTS In total, 1894 patients were analysed-50.9% were male, mean age was 72.4 (SD±12.3) years, and Phase of Illness at the time of admission to the palliative care unit comprised 177 (8.9%) stable, 579 (29.2%) unstable, 921 (46.4%) deteriorating and 217 (10.9%) terminal phases. Symptoms were most distressing in the terminal phase for all items, followed by deteriorating, unstable and stable (p<0.001). The stable phase had lower association with shortness of breath (OR 0.73, 95% CI 0.57 to 0.94) and felt at peace (OR 0.73, 95% CI 0.56 to 0.90) than the unstable phase. In the deteriorating phase, weakness or lack of energy (OR 1.20, 95% CI 1.02 to 1.40) were higher, while drowsiness (OR 0.82, 95% CI 0.71 to 0.97) and felt at peace (OR 0.81, 95% CI 0.71 to 0.94) were significantly lower. CONCLUSION Our study is reflective of the situation in palliative care units in Japan. Future studies should consider the differences in patients' medical conditions and routinely investigate patients' Phase of Illness and symptoms. TRIAL REGISTRARION NUMBER UMIN000025457.
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Affiliation(s)
- Hironori Ohinata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University, Sendai, Japan
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Ayako Kikuchi
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Yosuke Matsuda
- Department of Palliative Medicine, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
| | - Hiroyuki Kohara
- Department of General Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kadono T, Ishiki H, Yokomichi N, Ito T, Maeda I, Hatano Y, Miura T, Hamano J, Yamaguchi T, Ishikawa A, Suzuki Y, Arakawa S, Amano K, Satomi E, Mori M. Malignancy-related ascites in palliative care units: prognostic factor analysis. BMJ Support Palliat Care 2024; 13:e1292-e1299. [PMID: 37080735 PMCID: PMC10850720 DOI: 10.1136/spcare-2023-004286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The prognostic factors in patients with malignancy-related ascites (MA) have been poorly investigated. This study aimed to evaluate both the prognostic impact of MA on terminally ill patients with cancer and the prognostic factors in those with MA. METHODS This was a post hoc analysis of a multicentre, prospective cohort study. Patients with advanced cancer admitted to palliative care units at 23 institutions and aged≥18 years were enrolled between January and December 2017. Overall survival (OS) was compared according to MA. A multivariate analysis was conducted to explore prognostic factors in patients with MA. RESULTS Of 1896 eligible patients, gastrointestinal and hepatobiliary pancreatic cancers accounted for 42.5%. 568 (30.0%) of the total had MA. Patients with MA had significantly shorter OS than those without MA (median, 14 vs 22 days, respectively; HR, 1.55; 95% CI, 1.39 to 1.72; p<0.01). A multivariate analysis showed that MA was a poor prognostic factor (HR, 1.30; 95% CI, 1.13 to 1.50; p<0.01) and that among patients with MA, significant poor prognostic factors were liver metastasis, moderately to severely reduced oral intake, delirium, oedema, gastric cancer, high serum creatinine, high serum C reactive protein, high serum total bilirubin, dyspnoea and fatigue, while significant good prognostic factors were female sex, good performance status, high serum albumin and colorectal cancer. CONCLUSIONS MA had a negative impact on survival in terminally ill patients with cancer. A multivariate analysis revealed several prognostic factors in patients with terminal cancer and MA.
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Affiliation(s)
- Toru Kadono
- Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Hiroto Ishiki
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
- Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital, Minato-ku, Tokyo, Japan
| | - Isseki Maeda
- Department of Palliative Medicine, Senri Chuo Hospital, Toyonaka, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ayaka Ishikawa
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Yuka Suzuki
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Sayaka Arakawa
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Koji Amano
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Eriko Satomi
- Department of palliative medicine, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
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Hiratsuka Y, Suh SY, Yoon SJ, Choi SE, Kim SH, Hui D, Cheng SY, Huang HL, Chen PJ, Peng JK, Mori M, Yamaguchi T, Maeda I, Tsuneto S, Morita T. How different are accuracies of clinicians' prediction of survival by assessment methods? Ann Palliat Med 2024; 13:49-56. [PMID: 38124473 DOI: 10.21037/apm-23-393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND No standardized method has been established for evaluating the accuracy of a clinicians' prediction of survival (CPS). Till now, no study has compared the accuracy of CPS according to the evaluation methods using the same dataset. We aimed to examine the accuracy of CPS by different statistical approaches in patients with far-advanced cancer. METHODS The current study was a secondary analysis of an international multicenter prospective cohort study. Newly admitted patients with advanced cancer were enrolled in palliative care units (PCUs) in Japan, Korea, and Taiwan. We obtained the temporal CPS at enrollment. The patients were classified into groups of days (≤7 days) and weeks (≤30 days) based on CPS and actual survival (AS). We evaluated the accuracy of CPS by the distribution, area under the receiver operating characteristics curve (AUROCs), and an estimate ±33% of AS. RESULTS A total of 2,571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. As for the "days" category, the distribution of AS is larger than that of CPS, however, the results are reversed in the "weeks" category. The AUROCs showed over 80% discrimination for both the "days" and "weeks" categories. Accurate CPS within ±33% of AS was approximately 30% in both "days" and "weeks" categories. CONCLUSIONS We showed a discrepancy of approximately 30-80% in the accuracy of CPS among three different analysis methods: distribution, AUROC, and AS comparison. Considering the low accuracy of AS comparisons, clinicians should provide a wide range of survival time. CPS was able to effectively discriminate and may be useful for risk stratification.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sun Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Takeda Y, Ishiki H, Oyamada S, Otani H, Maeda I, Yamaguchi T, Hamano J, Mori M, Morita T. Symptoms and Prognoses of Patients With Breast Cancer and Malignant Wounds in Palliative Care Units: The Multicenter, Prospective, Observational EASED Study. Am J Hosp Palliat Care 2023:10499091231219855. [PMID: 38056829 DOI: 10.1177/10499091231219855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study sought to investigate the symptoms and prognoses of patients with breast cancer and malignant wounds in the palliative care unit setting. METHODS This study was a sub-group analysis of a multicenter, prospective, observational study. Patients admitted to 23 palliative care units in Japan between January and December 2017 were enrolled. Data of patients with breast cancer were extracted. We compared demographic characteristics, symptoms, and prognoses by breast cancer malignant wound status. The primary outcome was overall survival. Secondary outcomes included Palliative Prognostic Index (PPI) score, malignant wound characteristics, and symptom burden. RESULTS Of 1896 patients, 131 (6.9%) had breast cancer. In this cohort, 44 (33.6%) patients had malignant wounds. Most malignant wounds (88%) were on the back and chest. Malignant wounds were associated with skin redness, erosion, necrosis, or fistula. Symptoms included bleeding, exudate, odor, and pain. Twenty-eight patients (63.6%) needed dressing changes and 14 (31.8%) patients experienced bleeding. None died due to bleeding. In the malignant wounds group, 32 (72.8%) patients had used an opioid dose equivalent to 38 mg of oral morphine daily, compared to 25 mg by 57 (65.5%) patients in the non-malignant wounds group (P = .26). Median PPI scores at hospital admission were 4.5 vs 6.5 (P = .08). Median survival was 23 vs 21 days (P = .48). CONCLUSIONS Patients with malignant wounds had a distinct symptom burden profile and tended to use a higher dose of opioids. The effect of malignant wounds on survival was unclear.
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Affiliation(s)
- Yuma Takeda
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
- Department of Palliative Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hiroyuki Otani
- Department of Palliative and Supportive Care, St. Mary's Hospital, Kurume, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | | | - Jun Hamano
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
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Yamaguchi T, Yokomichi N, Yamaguchi T, Maeda I, Matsunuma R, Tanaka-Yagi Y, Akatani A, Suzuki K, Kohara H, Taniyama T, Matsuda Y, Nakajima N, Morita T, Tsuneto S, Mori M. Anticholinergic drugs for death rattle in dying patients with cancer: multicentre prospective cohort study. BMJ Support Palliat Care 2023; 13:462-471. [PMID: 36357162 DOI: 10.1136/spcare-2022-003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/28/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study aimed to investigate the effectiveness of anticholinergics (AC) for death rattle in dying patients with cancer. METHODS This is a prospective cohort study enrolled Terminally ill adult (20 years or older) patients with cancer who developed substantial death rattle (Back score ≥2) from 23 palliative care units in Japan. AC treatment for death rattle was prescribed according to primary physician's decision. The primary outcome was the proportion of patients whose death rattle improved, which was defined as a Back score of ≤1. We compared the proportion of improved cases in patients treated with (AC group) and without (non-AC group) AC, controlling potential confounders by employing propensity score weighting. RESULTS Of the 1896 patients enrolled, we included 196 who developed a substantial death rattle. Of these, 81 received AC. 56.8% in the AC group and 35.4% in the non-AC group had an improved death rattle at 8 hours after baseline. In the weighted analysis, AC group showed significant improvements in death rattle, with an adjusted OR of 4.47 (95% CI 2.04 to 9.78; p=0.0024). All sensitivity analyses achieved essentially the same results. In the subgroup analysis, ACs were strongly associated with death rattle improvement in men, patients with lung cancer, and type 1 death rattle (adjusted OR 5.81, 8.38 and 9.32, respectively). CONCLUSIONS In this propensity score-weighted analysis, ACs were associated with death rattle improvement in terminally ill patients with cancer who developed substantial death rattle. TRIAL REGISTRATION NUMBER UMIN-CTR (UMIN00002545).
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Affiliation(s)
- Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Osaka, Japan
| | - Ryo Matsunuma
- Department of Palliative Care, Konan Medical Center, Kobe, Hyogo, Japan
| | | | - Asami Akatani
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Kohara
- Department of Palliative Care, Hatsukaichi Memorial Hospital, Hatsukaichi, Hiroshima, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Care, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Department of Palliative Care, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and Internal Medicine, University of the Ryukyus Hospital, Nishihara, Okinawa, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Maeda S, Morita T, Yokomichi N, Imai K, Tsuneto S, Maeda I, Miura T, Ishiki H, Otani H, Hatano Y, Mori M. Continuous Deep Sedation for Psycho-Existential Suffering: A Multicenter Nationwide Study. J Palliat Med 2023; 26:1501-1509. [PMID: 37289183 DOI: 10.1089/jpm.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Background: There is ongoing debate on whether continuous deep sedation (CDS) for psycho-existential suffering is appropriate. Objective: We aimed to (1) clarify clinical practice of CDS for psycho-existential suffering and (2) assess its impact on patients' survival. Methods: Advanced cancer patients admitted to 23 palliative care units in 2017 were consecutively enrolled. We compared patients' characteristics, CDS practices, and survival between those receiving CDS for psycho-existential suffering ± physical symptoms and only for physical symptoms. Results: Of 164 patients analyzed, 14 (8.5%) received CDS for psycho-existential suffering ± physical symptoms and only one of them (0.6%) solely for psycho-existential suffering. Patients receiving CDS for psycho-existential suffering, compared with those only for physical symptoms, were likely to have no specific religion (p = 0.025), and desired (78.6% vs. 22.0%, respectively; p < 0.001) and requested a hastened death more frequently (57.1% vs. 10.0%, respectively; p < 0.001). All of them had a poor physical condition with limited estimated survival, and mostly (71%) received intermittent sedation before CDS. CDS for psycho-existential suffering caused greater physicians' discomfort (p = 0.037), and lasted for longer (p = 0.029). Dependency, loss of autonomy, and hopelessness were common reasons for psycho-existential suffering that required CDS. The survival time after CDS initiation was longer in patients receiving it for psycho-existential suffering (log-rank, p = 0.021). Conclusion: CDS was applied to patients who suffered from psycho-existential suffering, which often associated with desire or request for a hastened death. Further studies and debate are warranted to develop feasible treatment strategies for psycho-existential suffering.
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Affiliation(s)
- Sayaka Maeda
- Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Research Association for Community Health, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Otani
- Department of Palliative and Supportive Care, St. Mary's Hospital, Fukuoka, Japan
- Department of Palliative and Supportive Care, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Amano K, Baracos V, Okamura S, Yamada T, Maeda I, Otani H, Ishiki H, Miura T, Hamano J, Hatano Y, Morita T, Mori M. Low serum creatinine as a prognostic marker in advanced cancer. BMJ Support Palliat Care 2023:spcare-2023-004646. [PMID: 37907252 DOI: 10.1136/spcare-2023-004646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To evaluate whether low serum creatinine levels are associated with poor outcomes in patients with advanced cancer. METHODS This is a secondary analysis of a prospective cohort study. Patients were divided into three groups according to their baseline serum creatinine levels. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests, and by conducting univariate and multivariate Cox regression analyses. RESULTS 809 males were divided: male-low group (n=192), male-normal group (n=403) and male-high group (n=214). 808 females were divided: female-low group (n=239), female-normal group (n=389) and female-high group (n=180). Significant differences were observed in survival rates between the high and normal groups in the males and females (both log-rank p<0.001). Significantly higher risks of mortality were observed in the Cox proportional hazard model for the high group than for the normal group in both sexes (adjusted HR 1.292, 95% CI 1.082 to 1.542; adjusted HR 1.316, 95% CI 1.094 to 1.583, respectively). High serum creatinine was associated with shorter survival than normal creatinine, while low serum creatinine was not. CONCLUSIONS Low serum creatinine levels did not have prognostic abilities in this population.
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Affiliation(s)
- Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Suita, Japan
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Vickie Baracos
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Satomi Okamura
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Hiroyuki Otani
- Department of Palliative and Supportive Care, St. Mary's Hospital, Kurume, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka, Japan
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9
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Shiraishi R, Kizawa Y, Mori M, Maeda I, Hatano Y, Ishiki H, Miura T, Yokomichi N, Kodama M, Inoue K, Otomo S, Yamaguchi T, Hamano J. Comparison of Symptom Severity and Progression in Advanced Cancer Patients Among Different Care Settings: A Secondary Analysis. Palliat Med Rep 2023; 4:139-149. [PMID: 37360680 PMCID: PMC10288302 DOI: 10.1089/pmr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Background Most people in Japan wish to spend their final days at home, but the majority fail to do so; earlier studies indicated a more pronounced worsening of symptoms if treated at home. Objectives This study compared the prevalence of symptom worsening and explored associated factors between patients with advanced cancer receiving palliative care in palliative care units (PCUs) and at home. Design We conducted a secondary analysis of two multicenter, prospective cohort studies involving patients with advanced cancer receiving palliative care in PCUs or at home. Setting/Subjects One study was conducted at 23 PCUs (January to December 2017) and the other on 45 palliative home care services (July to December 2017) in Japan. Measurements Symptom changes were categorized as stable, improved, or worse. Results Of the 2998 registered patients, 2877 were analyzed. Among them, 1890 patients received palliative care in PCUs, and 987 at home. Patients receiving palliative care at home were more likely to have worsening of pain (17.1% vs. 3.8%; p < 0.001) and drowsiness (32.6% vs. 22.2%; p < 0.001) than those in PCUs. By multivariate logistic regression analysis, palliative care at home was significantly associated with worsening of the Palliative Prognostic Index dyspnea subscale in the unadjusted model (odds ratio, 1.42 [95% confidence interval, 1.08-1.88]; p = 0.014) but not for any symptoms in the adjusted model. Conclusions After adjusting for patient background, the prevalence of symptom worsening was not different between patients with advanced cancer receiving palliative care at home and in PCUs.
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Affiliation(s)
- Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Yoshiyuki Kizawa
- Division of Clinical Medicine, Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Keiko Inoue
- Medical Corporation Aisei-kai, Hirakata, Japan
| | | | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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10
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Hiratsuka Y, Hamano J, Mori M, Maeda I, Morita T, Suh SY. Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities. J Hosp Palliat Care 2023; 26:1-6. [PMID: 37753320 PMCID: PMC10519719 DOI: 10.14475/jhpc.2023.26.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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11
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Imai K, Morita T, Mori M, Kiuchi D, Yokomichi N, Miwa S, Okamoto S, Yamauchi T, Naito AS, Matsuda Y, Maeda I, Sugano K, Ikenaga M, Inoue S, Satomi E. Visualizing How to Use Antipsychotics for Agitated Delirium in the Last Days of Life. J Pain Symptom Manage 2023; 65:479-489. [PMID: 36682673 DOI: 10.1016/j.jpainsymman.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
CONTEXT How physicians use antipsychotics for agitated delirium in the last days of life varies markedly, which could hamper the quality of care. OBJECTIVES To examine adherence to an algorithm-based treatment for terminal agitated delirium, and explore its effectiveness and safety. METHODS A single-center, prospective, observational study was conducted in a 27-bed palliative care unit in Japan. All adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS) of +1 or more were included; the palliative care specialists determined that the etiology was irreversible, the estimated survival was three weeks or less, and the Eastern Cooperative Oncology Group (ECOG) performance status was three or four. Patients were treated with an algorithm to visualize how to use antipsychotics, with the treatment goal defined as no agitation (RASS≤0) or acceptable agitation for patients and families. We provided all patients nonpharmacological management to alleviate the symptoms of delirium and administered antipsychotic medications when the nonpharmacological approach was insufficient. We measured the adherence rate, RASS, Nursing Delirium Screening Scale items 2, 3, 4 (Nu-DESC), and Agitation Distress Scale item 2 (ADS) on days 0, 1, 3, 7, 14, 21, and 24 hours before death. RESULTS A total of 164 patients were enrolled. Adherence rates were 99, 94, and 89%, and treatment goals were achieved in 66, 83, and 93% on days one, three, and seven, respectively. The mean RASS decreased from +1.41 to -0.84 on day three; Nu-DESC decreased from 4.19 to 1.83, and ADS decreased from 1.54 to 0.38. There were seven severe adverse events (Common Terminology Criteria for Adverse Events (CTCAE) of 3), including aspiration (n = 3), apnea (n = 2), tremor (n = 1), and muscle rigidity (n = 1) on day three. CONCLUSION The algorithm-based treatment could be feasible, effective, and safe. Visualizing how palliative care specialists provide pharmacological management could be beneficial for nonspecialist clinicians, and clinical, educational, and research implications warrant further empirical testing.
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Affiliation(s)
- Kengo Imai
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan.
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Satoru Miwa
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | | | - Toshihiro Yamauchi
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care (A.S.N.), Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine (Y.M.), National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Seri-Chuo Hospital, Toyonaka, Japan
| | - Koji Sugano
- Division of Respiratory Medicine (K.S.), Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Ikenaga
- Department of Palliative Medicine (M.I.), Yodogawa Christian Hospital, Osaka, Japan
| | - Satoshi Inoue
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
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12
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Imai H, Mori T, Sakayori M, Mori M, Maeda I, Hamano J, Ishioka C, Inoue A. Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study. Jpn J Clin Oncol 2023; 53:410-418. [PMID: 36647604 DOI: 10.1093/jjco/hyad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer. METHODS This single-center, follow-up cohort study included Japanese patients with advanced cancer who received chemotherapy at Tohoku University Hospital between January 2015 and January 2016. Patients were surveyed at enrollment and followed up for clinical events for 5 years thereafter. We compared (i) the patients' prognostic awareness with both actual survival time and physician's prediction of survival and (ii) physician's prediction of survival time with actual survival. Factors associated with accurate prognostic awareness were identified by univariate analysis. RESULTS Of the 133 patients eligible for the study, 57 patients were analyzed. Only 10 (17.5%) patients had accurate prognostic awareness. Forty-three patients (75.4%) were optimistic about their prognosis; >80% of patients were more optimistic than their physicians about their prognosis. The physicians' predictions were accurate in for patients (37.5%). Accurate prognostic awareness was associated with physician's explanation of the prognosis and patients' perception of a good death. CONCLUSIONS A majority of the patients with advanced cancer in this study had prognostic awareness that was more optimistic in comparison with their actual survival, and most were more optimistic than their physicians about their prognosis. Further research is needed to develop programs to facilitate the discussion of life expectancy with patients in a manner that is consistent with their preferences.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Oishi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Mori
- Department of Medical Oncology and Hematology, Okinawa Chubu Hospital, Uruma, Japan
| | - Masato Sakayori
- Department of Internal Medicine, Sodegaura Satsukidai Hospital, Sodegaura, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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13
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Abe A, Fujisawa D, Miyajima K, Takeuchi E, Takeuchi M, Mimura M, Imai K, Uemura K, Watanabe H, Matsuo N, Matsuda Y, Maeda I, Ogawa A, Yoshiuchi K, Iwase S. Influence of dosing pattern of antipsychotics on treatment outcome of delirium in patients with advanced cancer. Jpn J Clin Oncol 2023; 53:321-326. [PMID: 36647601 DOI: 10.1093/jjco/hyac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinical guidelines recommend antipsychotics for the treatment of delirium; however, there has been no confirmed recommendation regarding their administrating patterns. This study aims to investigate whether different dosing patterns of antipsychotics (single or multiple administrations) influence the outcomes of delirium treatment. METHODS This is a secondary analysis of a prospective observational study involving patients with advanced cancer and delirium receiving antipsychotics. The Delirium Rating Scale Revised-98 was administered at baseline and after 72 h of starting pharmacotherapy. Patients were classified into single administration group (received a single dosage within 24 h before the assessment) and multiple administration group (received more than one dosage). RESULTS A total of 555 patients (single administration 492 (88.6%); multiple administration 63 (11.4%)) were subjected to analyses. The patients in the multiple administration group were more likely to be male, in psycho-oncology consulting settings, with lower performance status, with hyperactive delirium and with severer delirium symptoms. In the multivariate analysis, single administration was significantly associated with better improvement of delirium (p < 0.01, 95% confidence interval: 1.83-5.87) even after controlling covariates. There were no significant differences in the mean dosages of antipsychotics per day in chlorpromazine equivalent (single administration 116.8 mg/day, multiple administration 123.5 mg/day) and the incidence of adverse events between the two groups. CONCLUSIONS In this observational study sample, Delirium Rating Scale severity score improvement in single administration was higher than that seen in multiple administration. There was no difference in adverse events between the two groups.
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Affiliation(s)
- Akiko Abe
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan.,Division of Patient Safety, Keio University Hospital, Tokyo, Japan
| | - Kaya Miyajima
- Department of Neuropsychiatry, Sakuramachi Hospital, Tokyo, Japan
| | - Emi Takeuchi
- Division of Quality Assurance Programs, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keiichi Uemura
- Department of Psychiatry, Tonan Hospital, Sapporo, Japan
| | | | - Naoki Matsuo
- Hospice Medical Corporation, Junkei-kai Sotoasahikawa Hospital, Akita, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
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14
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Hui D, Agar M, Maeda I. Should Neuroleptics Be Used in Patients With Delirium Seen by Palliative Care? J Pain Symptom Manage 2023; 65:e81-e85. [PMID: 36220457 DOI: 10.1016/j.jpainsymman.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Delirium commonly occurs in the palliative care setting and impacts many aspects of patient care, such as symptom assessment, patient-clinician communication, and medical decision-making. One controversial topic regarding the management of delirium in the palliative care setting is whether neuroleptics should be used. In this "Controversies in Palliative Care" article, 3 expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all 3 experts arrived at similar conclusions-they underscored the importance of identification and treatment of any reversible causes of delirium and endorsed a trial of non-pharmacologic measures. They also agreed that neuroleptics should be considered for patients with hyperactive or mixed delirium when the conservative measures fail to control delirium symptoms and for delirious patients with days of life expectancy and thus limited time to try other measures. Risk of adverse effects such as extrapyramidal symptoms and seizures should be considered as part of the treatment decision. There is also a need to conduct high quality research to examine both neuroleptics and neuroleptic-sparing strategies for the management of delirium.
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Affiliation(s)
- David Hui
- Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Meera Agar
- IMPACCT Centre (M.A.), University of Technology Sydney, Sydney, Australia
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan
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15
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Hamano J, Takeuchi A, Mori M, Saitou Y, Yamaguchi T, Miyata N, Shimizu M, Yamamoto R, Kimura Y, Kamiyama Y, Arai Y, Matsuo H, Shishido H, Nakano K, Nishi T, Nagaoka H, Yokomichi N, Maeda I, Yamaguchi T, Morita T, Shinjo T. Comparison of survival times of advanced cancer patients with palliative care at home and in hospital. PLoS One 2023; 18:e0284147. [PMID: 37053183 PMCID: PMC10101528 DOI: 10.1371/journal.pone.0284147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES One primary concern about receiving care at home is that survival might be shortened because the quality and quantity of treatment provided at home will be inferior to that given in the hospital. Although our previous study demonstrated a longer survival of those with home-based palliative care (PC), it lacked adjustment for some potential confounders including symptoms and treatments during the stay. We aimed to compare the survival times among advanced cancer patients receiving home-based and hospital-based PC with adjusting for symptoms and treatments. METHOD We compared survival time of participants who enrolled two multicenter, prospective cohort studies of advanced cancer patients at 45-home-based PC services between July 2017 and December 2017, and at 23-hospital-based PC services between January 2017 and December 2017. We analyzed with stratification by the estimated survival of Days, Weeks, and Months, which were defined by modified Prognosis in Palliative care Study predictor models-A. We conducted a Cox regression analysis with adjusting for potential confounders including symptoms and treatments during the stay. RESULTS A total of 2,998 patients were enrolled in both studies and 2,878 patients were analyzed; 988 patients receiving home-based PC and 1,890 receiving hospital-based PC. The survival time of patients receiving home-based PC was significantly longer than that of patients receiving hospital-based PC for the Days Prognosis (estimated median survival time: 10 days [95% CI 8.1-11.8] vs. 9 days [95% CI 8.3-10.4], p = 0.157), the Weeks prognosis (32 days [95% CI 28.9-35.4] vs. 22 days [95% CI 20.3-22.9], p < 0.001), and the Months Prognosis, (65 days [95% CI 58.2-73.2] vs. 32 days [95% CI 28.9-35.4], p < 0.001). CONCLUSION In this cohort of advanced cancer patients with a Weeks or Months prognosis, those receiving home-based PC survived longer than those receiving hospital-based PC after adjusting for symptoms and treatments.
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Affiliation(s)
- Jun Hamano
- Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | | | | | | | - Ryo Yamamoto
- Saku Central Hospital Advanced Care Center, Saku-shi, Nagano, Japan
| | | | | | | | | | | | | | - Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroka Nagaoka
- Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Takashi Yamaguchi
- Department of Medicine, Division of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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16
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Hamano J, Hiratsuka Y, Morita T, Kizawa Y, Maeda I, Mori M. Preference of Japanese cancer patients for being informed about their prognosis. Ann Palliat Med 2022; 11:3426-3435. [DOI: 10.21037/apm-22-772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
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17
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Ikari T, Hiratsuka Y, Cheng SY, Miyashita M, Morita T, Mori M, Uneno Y, Amano K, Uehara Y, Yamaguchi T, Maeda I, Inoue A. Factors associated with good death of patients with advanced cancer: a prospective study in Japan. Support Care Cancer 2022; 30:9577-9586. [PMID: 36125610 DOI: 10.1007/s00520-022-07363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE It is important for palliative care providers to identify what factors are associated with a "good death" for patients with advanced cancer. We aimed to identify factors associated with a "good death" evaluated by the Good Death Scale (GDS) score among inpatients with advanced cancer in palliative care units (PCUs) in Japan. METHODS The study is a sub-analysis of a multicenter prospective cohort study conducted in Japan. All variables were recorded on a structured data collecting sheet designed for the study. We classified each patient into better GDS group or worse GDS group, and examined factors associated with better GDS using multivariate analysis. RESULTS Between January and December 2017, 1896 patients were enrolled across 22 PCUs in Japan. Among them, a total of 1157 patients were evaluated. Five variables were significantly associated with a better GDS score in multivariate analysis: preferred place of death at PCU (odds ratio [OR] 2.85; 95% confidence interval [CI] 1.72-4.71; p < 0.01), longer survival time (OR 1.02; 95% CI 1.00-1.03; p < 0.01), not sudden death (OR 1.96; 95% CI 1.27-3.04; p < 0.01), better spiritual well-being in the last 3 days in life (OR 0.53; 95% CI 0.42-0.68; p < 0.01), and better communication between patient and family (OR 0.81; 95% CI 0.66-0.98; p = 0.03). CONCLUSIONS We identified factors associated with a "good death" using GDS among advanced cancer patients in Japanese PCUs. Recognition of factors associated with GDS could help to improve the quality of end-of-life care.
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Affiliation(s)
- Tomoo Ikari
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan. .,Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Isseki Maeda
- Department of Palliative Care Senri-Chuo Hospital, Toyonaka, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Hiratsuka Y, Suh SY, Hui D, Morita T, Mori M, Oyamada S, Amano K, Imai K, Baba M, Kohara H, Hisanaga T, Maeda I, Hamano J, Inoue A. Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models. J Pain Symptom Manage 2022; 64:391-399. [PMID: 35724924 DOI: 10.1016/j.jpainsymman.2022.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Several prognostic models such as the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) have been developed to complement clinician's prediction of survival (CPS). However, few studies with large scales have been conducted to show which prognostic tool had better performance than CPS in patients with weeks of survival. OBJECTIVES We aimed to compare the prognostic performance of the PPS, PPI, PaP, and CPS in inpatients admitted to palliative care units (PCUs). METHODS This study was part of a multi-center prospective observational study involving patients admitted to PCUs in Japan. We computed their prognostic performance using the area under the receiver operating characteristics curve (AUROC) and calibration plots for seven, 14-, 30- and 60-day survival. RESULTS We included 1896 patients with a median overall survival of 19 days. The AUROC was 73% to 84% for 60-day and 30-day survival, 75% to 84% for 14-day survival, and 80% to 87% for seven-day survival. The calibration plot demonstrated satisfactory agreement between the observational and predictive probability for the four indices in all timeframes. Therefore, all four prognostic indices showed good performance. CPS and PaP consistently had significantly better performance than the PPS and PPI from one-week to two-month timeframes. CONCLUSION The PPS, PPI, PaP, and CPS had relatively good performance in patients admitted to PCUs with weeks of survival. CPS and PaP had significantly better performance than the PPS and PPI. CPS may be sufficient for experienced clinicians while PPS may help to improve prognostic confidence for inexperienced clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sang-Yeon Suh
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - David Hui
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Morita
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shunsuke Oyamada
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Amano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kengo Imai
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mika Baba
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Kohara
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isseki Maeda
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Jun Hamano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Inoue
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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19
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Asai M, Matsumoto Y, Miura T, Hasuo H, Maeda I, Ogawa A, Morita T, Uchitomi Y, Kinoshita H. Psychological Distress among Caregivers for Patients Who Die of Cancer: A Preliminary Study in Japan. J NIPPON MED SCH 2022; 89:428-435. [DOI: 10.1272/jnms.jnms.2022_89-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mariko Asai
- Graduate School of Clinical Psychology, Teikyo Heisei University
| | | | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital
| | - Asao Ogawa
- Psycho-Oncology Division, National Cancer Center Hospital East
| | - Tatsuya Morita
- Palliative and Supportive Care, Seirei Mikatahara Hospital
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Yokomichi N, Maeda I, Morita T, Yoshiuchi K, Ogawa A, Hisanaga T, Sakashita A, Nakahara R, Kaneishi K, Iwase S. Association of Antipsychotic Dose With Survival of Advanced Cancer Patients With Delirium. J Pain Symptom Manage 2022; 64:28-36. [PMID: 35339614 DOI: 10.1016/j.jpainsymman.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Delirium is common in patients with advanced cancer, and antipsychotics are widely used for its management. OBJECTIVES We aimed to explore the association of the antipsychotic dose with survival of terminally ill cancer patients with delirium. METHODS A secondary analysis of a multicenter prospective observational study was conducted. We enrolled adult advanced cancer patients who developed delirium and received antipsychotics at 14 palliative care units in Japan between September 2015 and May 2016. Hazard ratios of survival after starting antipsychotics between groups with different oral chlorpromazine equivalent doses: low: <100 mg, moderate: 100-200 mg, high: ≥200 mg, were calculated with adjustment for potential confounders using Cox regression. The antipsychotic dose-specific mortality risk was estimated with smooth splines. RESULTS Of 453 patients enrolled, 422 patients were analyzed. The median antipsychotic dose was 92.6 mg: low-dose (N = 231), moderate-dose (122), and high-dose (69). The median survival of all patients was 11 days. Compared with the low-dose group, the high-dose group showed a significantly shorter survival (HR: 1.46, 95%CI: 1.08-1.98). Smooth splines demonstrated that HR continuously increased as the antipsychotic dose increased. In patients treated with atypical antipsychotics, the high-dose group showed a significantly shorter survival than the low-dose group (HR: 2.86), while in patients treated with typical antipsychotics, survival was not significantly different (0.99). CONCLUSIONS Higher doses of antipsychotics were associated with increased mortality in terminally ill cancer patients with delirium. To minimize the potential mortality risk, antipsychotics should be started at low doses and titrated carefully.
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Affiliation(s)
- Naosuke Yokomichi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan.
| | - Isseki Maeda
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Kazuhiro Yoshiuchi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Asao Ogawa
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Takayuki Hisanaga
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Akihiro Sakashita
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Rika Nakahara
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Keisuke Kaneishi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Satoru Iwase
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
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21
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Hiramoto S, Oya K, Tokutani R, Kirishima T, Maeda I, Tetsuo H, Amano K, Yamauchi T, Hiratsuka Y. Prognostic impact of systemic anti-cancer therapy on patients with advanced cancer at end of life: Analysis of a multicenter prospective cohort study using propensity score methods. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12029 Background: Prognosis is said to worsen when systemic anti-cancer therapy (SACT) is administered until a patient’s end of life (EOL) and professional palliative care is delayed. However, the prognostic impact of SACT at EOL is unclear. Methods: In this pre-planned secondary analysis of a multicenter, prospective East Asian cross-cultural collaborative cohort study, consecutive patients with advanced cancer admitted to palliative care units between January and December 2017 were divided into four groups: patients who had and had not received SACT (SACT vs. non-SACT) and patients whose last administration of SACT was before or within 1 month of study enrolment (non-1M SACT vs. 1M SACT). The primary endpoint was difference in survival time from a palliative performance scale (PPS) of < 20 to death between the SACT and non-SACT groups, and the 1M SACT and non-1M SACT groups. The analysis was adjusted for age; sex; primary cancer site; metastatic site; comorbidity (Charlson comorbidity index); and history of radiotherapy, smoking, and psychiatric disorders. Weighting for inverse probability of treatment was applied. A secondary endpoint was to identify EOL symptom and care factors prognostic for survival time using a Cox proportional hazards model. Results: The 1396 study patients (712 men, 684 women; median age: 73 years) came from 21 institutions throughout Japan. Primary tumor sites were upper gastrointestinal (471 patients), lower gastrointestinal (193 patients), lung (241 patients), breast (93 patients), urologic (101 patients), gynecologic (82 patients), head and neck (56 patients), central nervous system (25 patients), and hematologic (39 patients). Metastatic sites were liver (554 patients), lung (522 patients), bone (373 patients), and brain (199 patients). The SACT, non-SACT, 1M SACT, and non-1M SACT groups consisted of 853, 539, 126, and 1270 patients, respectively. Survival time was significantly shorter in the SACT group (6.83 days, p = 0.03) than in the non-SACT group (9.01 days). No significant difference between the 1M SACT group (7.57 days) and the non-1M SACT group (7.36 days) was evident. Prognostic factors were use of opioids (HR 1.289), antipsychotics (HR 0.787), and anxiolytics (HR 0.867); infusion of more than 1 L daily (HR 0.727); and apnea (HR 0.874), dyspnea (HR 1.874), nausea (HR 0.612), fatigue (HR 1.284), and ascites (HR 1.236). Conclusions: Prognosis was shorter for patients with a history of SACT than for those without a history of SACT at EOL. However, SACT at EOL was not a prognostic factor. This information is useful in advance care planning for selecting and explaining treatment at EOL to patients and their families.
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Affiliation(s)
| | | | | | | | | | | | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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22
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Yamaguchi T, Mori M, Maeda I, Matsunuma R, Tanaka-Yagi Y, Nishi T, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. The impact of death rattle on bereaved families: not the sound itself, but the resonance with their feelings. Jpn J Clin Oncol 2022; 52:774-778. [PMID: 35446952 DOI: 10.1093/jjco/hyac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to explore (i) the consistency between physician-rated and bereaved family-perceived intensity of death rattle, (ii) the relationship between intensity of death rattle and the bereaved family's distress and (iii) the bereaved family's experience and feelings related to suctioning for death rattle. METHODS We used matched data for deceased patients from a prospective cohort study of cancer patients admitted to a palliative care unit, and their bereaved families from a nationwide questionnaire survey in Japan. The intensity of death rattle using Back's score was evaluated prospectively by physicians and retrospectively by bereaved families. RESULTS In total, 1122 bereaved families answered (response rate: 66.7%). Of these, 297 reported the development of death rattle. The maximum intensity of death rattle evaluated by physicians and perceived by bereaved families was poorly correlated (Spearman correlation coefficient 0.188, P = 0.082). The optimal cut-off point of Back's score for detecting high-level distress was 1/2, with a low accuracy of prediction (area under the curve 0.62). More than 70% of bereaved families indicated suctioning reduced the intensity of death rattle, made patients comfortable and themselves relieved, whereas a similar proportion felt patients were in distress during suctioning. Families who felt suctioning was gently performed and discussed well whether to do suctioning with health care providers felt less needs for improvement. CONCLUSIONS Bereaved family-perceived intensity of death rattle did not correlate to physician-evaluated intensity, and the intensity of death rattle itself seemed to poorly correlate to family distress. Gently performed suctioning based on sufficient discussion with families can help reduce family-perceived patient discomfort.
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Affiliation(s)
- Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Suita, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Yukako Tanaka-Yagi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Tomohiro Nishi
- Department of Palliative Care, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kento Masukawa
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Inoue S, Maeda I, Ogawa A, Yoshiuchi K, Terada S, Yamada N. Safety and Effectiveness of Perospirone in Comparison to Risperidone for Treatment of Delirium in Patients with Advanced Cancer: A Multicenter Prospective Observational Study in Real-World Psycho-Oncology Settings. Acta Med Okayama 2022; 76:195-202. [PMID: 35503448 DOI: 10.18926/amo/63414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The clinical benefit of perospirone for treatment of delirium in patients with advanced cancer is not sufficiently clear. The objective of this study was to compare the safety and effectiveness of perospirone to those of risperidone for the treatment of delirium in patients with advanced cancer. This is a secondary analysis of a multicenter prospective observational study in nine psycho-oncology consultation services in Japan. The study used the Delirium Rating Scale (DRS) Revised-98 to measure effectiveness and the CTCAE (Common Terminology Criteria for Adverse Events) version 4 to assess safety. Data from 16 patients who received perospirone and 53 patients who received risperidone were analyzed. The mean age was 70 years in the perospirone group and 73 years in the risperidone group. Both groups showed a significant decrease in the total score of DRS-R-98 after three days of treatment (perospirone: 11.7 (7.9-15.4) to 7.0 (3.3-10.7), difference -4.7, effect size=0.72, p=0.003; risperidone: 15.5 (13.6-17.4) to 12.2 (10.1-14.2), difference -3.3, effect size=0.55, p=0.00). The risperidone group showed significant improvements in sleep-wake cycle disturbance, orientation, attention, and visuospatial ability. In the perospirone group, there was a significant improvement of sleep-wake cycle disturbance. The median daily dose of perospirone was 4 mg/day. There were fewer episodes of somnolence as an adverse event in the perospirone group. Low-dose perospirone was thus found to be effective for the treatment of delirium in patients with advanced cancer and may be associated with fewer episodes of over-sedation as an adverse event.
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Affiliation(s)
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital
| | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo
| | - Seishi Terada
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Norihito Yamada
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Odagiri T, Maeda I, Masanori Mori, Morita T, Kaneishi K, Junko Nozato, Kazuhiro Kosugi, Higashibata T, Hamano J, Shimoinaba J, Nishi T, Kawashima N. Title: Effects of Antibiotics on Respiratory Symptoms in Terminally Ill Cancer Patients With Pneumonia: A Multicenter Cohort Study. Am J Hosp Palliat Care 2022; 39:1082-1089. [PMID: 35341338 DOI: 10.1177/10499091211058156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Patients in the terminal stages of cancer are frequently affected by infection, especially pneumonia; but the effects of antibiotics on respiratory symptoms and factors associated with improvement are still unclear. OBJECTIVES This study aimed to clarify the effects of antibiotics on respiratory symptoms of terminally ill cancer patients with pneumonia, and to explore factors associated with the improvement. METHODS This was a prospective cohort study in which we consecutively recruited terminally ill cancer patients diagnosed with pneumonia and treated with antibiotics at one of 23 palliative care units across Japan. At the baseline and Day 3, primarily responsible palliative care specialists recorded patient backgrounds, the results of physical and laboratory examination, and patient symptoms using the Support Team Assessment Schedule. Improvement was defined as improvement of dyspnea, cough, and sputum production on Day 3. RESULTS Among all 1896 patients admitted during the study periods, 137 patients (7.2%) were enrolled into this study. Improvement was achieved in 65 patients (47.4%; 95% confidence intervals, 39-56). Univariate analyses revealed that the Palliative Prognostic Index (PPI), respiratory rate (RR), and oxygen requirement were significantly associated with the improvement. A multiple logistic regression analysis identified that PPI score of ≤ 6 and RR of <20 were independently associated with the improvement (odds ratios, 4.4 [1.6-12] and 2.5 [1.1-5.5], respectively). CONCLUSION Antibiotics may relieve respiratory symptoms from pneumonia in approximately half of the terminally ill cancer patients. PPI and respiratory rate are useful to identify the patients who received benefits of antibiotics.
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Affiliation(s)
- Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Genral Hospital, Hamamatsu, Japan
| | - Keisuke Kaneishi
- Department of Palliative Internal Medicine, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Junko Nozato
- Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, 26351National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Higashibata
- Palliative Care Team, Department of General Medicine and Primary Care, 68320University of Tsukuba Hospital, Tsukuba, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center, Kawasaki, Japan
| | - Natsuki Kawashima
- Department of Palliative Medicine, 26420Tsukuba Medical Center Hospital, Tsukuba, Japan
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Yokota S, Amano K, Oyamada S, Ishiki H, Maeda I, Miura T, Hatano Y, Uneno Y, Hori T, Matsuda Y, Kohara H, Suzuki K, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Yamauchi T, Naito AS, Yoshioka A, Hiramoto S, Kikuchi A, Tanaka K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Oya K, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Sakashita A, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Nakagawa J, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Hiratsuka Y, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Appointed S, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Watanabe YS, Uehara Y, Satomi E, Nishijima K, Shimoinaba J, Nakahori R, Hirohashi T, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. Effects of artificial nutrition and hydration on survival in patients with head and neck cancer and esophageal cancer admitted to palliative care units. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yokomichi N, Yamaguchi T, Maeda I, Mori M, Imai K, Shirado Naito A, Yamaguchi T, Terabayashi T, Hiratsuka Y, Hisanaga T, Morita T. Effect of continuous deep sedation on survival in the last days of life of cancer patients: A multicenter prospective cohort study. Palliat Med 2022; 36:189-199. [PMID: 35067124 DOI: 10.1177/02692163211057754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Continuous deep sedation is ethically controversial with respect to whether it shortens a patient's life. AIM To examine whether continuous deep sedation shortens patient survival from the day of Palliative Performance Scale decline to 20 (PPS20). DESIGN A part of a multicenter prospective cohort study (EASED study). SETTING/PARTICIPANTS We recruited consecutive adult patients with advanced cancer admitted to 23 participating palliative care units in 2017 in Japan. We compared survival from PPS20 between those who did and did not receive continuous deep sedation. Continuous deep sedation was defined as the continuous administration of sedative medication with the intention to keep a patient continuously unconscious to alleviate otherwise uncontrollable symptoms, but the dose of sedatives was adjusted to achieve adequate symptom relief for each patient. The propensity score-weighting method was used to control for potential confounders, and five sensitivity analyses were performed. RESULTS A total of 1926 patients were enrolled. Patients discharged alive were excluded, and we analyzed 1625 patients of whom 156 (9.6%) received continuous deep sedation. Median survival from PPS20 of 1625 patients was 81 h (95% CI: 77-88). The RASS scores decreased to ⩽-4 was 66% at 24 h. Continuous deep sedation was not associated with a significant survival risk (adjusted hazard ratio: 1.06, 95% CI: 0.85-1.33). All sensitivity analyses, including continuous deep sedation defined as the RASS score was ⩽-4 achieved the essentially the same results. CONCLUSIONS Continuous deep sedation with careful dose adjustment was not associated with shorter survival in the last days of life in patients with advanced cancer.
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Affiliation(s)
- Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | | | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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27
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Hatano Y, Morita T, Mori M, Maeda I, Oyamada S, Naito AS, Oya K, Sakashita A, Ito S, Hiratsuka Y, Tsuneto S. Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis. Palliat Support Care 2021; 19:646-655. [PMID: 33641697 DOI: 10.1017/s1478951521000080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups. METHODS Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD. RESULTS Data from 971 patients, whose Richmond Agitation-Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16-20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): "physical distress," cluster 2 (21%, 37/173): "dependent and burdensome," cluster 3 (19%, 33/173): "hopelessness," cluster 4 (17%, 30/173): "profound fatigue," and cluster 5 (7%, 12/173): "extensive existential suffering." CONCLUSIONS A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.
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Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | | | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Satoko Ito
- Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Imai K, Morita T, Yokomichi N, Kawaguchi T, Kohara H, Yamaguchi T, Kikuchi A, Odagiri T, Watanabe YS, Kamura R, Maeda I, Kawashima N, Ito S, Baba M, Matsuda Y, Oya K, Kaneishi K, Hiratsuka Y, Naito AS, Mori M. Efficacy of Proportional Sedation and Deep Sedation Defined by Sedation Protocols: A Multicenter, Prospective, Observational Comparative Study. J Pain Symptom Manage 2021; 62:1165-1174. [PMID: 34118372 DOI: 10.1016/j.jpainsymman.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
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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Affiliation(s)
- Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital (K.I.), Hamamatsu, Japan.
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy (T.K.), Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care (T.Y.), Konan Medical Center, Kobe, Japan
| | - Ayako Kikuchi
- Department of Oncology and Palliative Medicine (A.K.), Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takuya Odagiri
- Komaki City Hospital (T.O.), Palliative Care, Komaki, Japan
| | - Yuki Sumazaki Watanabe
- Department of Palliative Medicine (Y.S.W.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Rena Kamura
- Hospice (R.K.), Yodogawa Christian Hospital, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Senri-Chuo Hospital, Toyonaka, Japan
| | - Natsuki Kawashima
- Department of Palliative Medicine (N.K.), Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Satoko Ito
- Hospice (S.I.), The Japan Baptist Hospital, Kyoto, Japan
| | - Mika Baba
- Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan
| | - Yosuke Matsuda
- Palliative Care Department (Y.M.), St. Luke's International Hospital, Tokyo, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care (K.O.), Aso Iizuka Hospital, Iizuka, Japan
| | - Keisuke Kaneishi
- Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine (Y.H.), Tohoku University School of Medicine, Sendai, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care (A.S.N.), Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Amano K, Satomi E, Oyamada S, Ishiki H, Sakashita A, Miura T, Maeda I, Hatano Y, Yamauchi T, Oya K, Nakagawa J, Hiratsuka Y, Hirohashi T, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Matsuda Y, Kohara H, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Sumazaki Watanabe Y, uehara Y, Nishijima K, Shimoinaba J, Nakahori R, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units. Clinical Nutrition Open Science 2021. [DOI: 10.1016/j.nutos.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tanaka H, Fukui S, Maeda I, Hatano Y, Higuchi A, Higami Y, Yamakawa M, Utsumi M. The change over time of vital signs with consideration for opioid use in the last 2 weeks of life among cancer patients in a palliative care unit: Continuous measurement of vital signs using a non-wearable monitor. Cancer Med 2021; 10:8799-8807. [PMID: 34845870 PMCID: PMC8683542 DOI: 10.1002/cam4.4382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim of this study was to examine the following by using a non‐wearable monitor: (ⅰ) the trajectory of vital signs (VS) in the last 2 weeks of life among cancer patients, and (ⅱ) the difference in change over time of VS between cancer patients with and without opioid use. Methods We conducted a longitudinal study involving cancer patients in a palliative care unit (PCU) from April 2018 to October 2019. VS were collected continuously using a non‐wearable monitor, and we calculated the means of respiratory rate (RR) and heart rate (HR) per hour, and counts of apnea per hour as outcome variables. Explanatory variables were time (subtracting time of death from measurement time of VS, divided by 36) and opioid use. Mean difference (MD) of time represented the slope per hour of VS values. First, we analyzed the associations between VS per hour and time using a linear mixed model (LMM) with random intercepts and slope over time. Second, we analyzed the associations between VS and interaction term between time and opioid use. Results We analyzed 26 cancer patients. RR (MD: 0.27 beats/min [95% CI: 0.27–0.28]), HR (MD: 1.51 beats/min [95% CI: 1.50–1.52]), and apnea (MD: 0.71 count/hour [95% CI: 0.70–0.72]) significantly increased hourly. In addition, RR was significantly associated with interaction term (MD: −1.59 beats/min [95% CI: −3.11 to −0.07]), which indicates that there is a difference in the slope of RR between opioid users and non‐users. Conclusions We have successfully described the trajectory of VS in high‐resolution under conditions of a natural end of life in PCU.
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Affiliation(s)
- Haruka Tanaka
- Graduate School of MedicineOsaka UniversityOsakaJapan
- Department of Integrated Health Sciences, Graduate School of MedicineNagoya UniversityAichiJapan
| | - Sakiko Fukui
- Graduate School of MedicineOsaka UniversityOsakaJapan
- Graduate School of Health ScienceTokyo Medical and Dental UniversityTokyoJapan
| | - Isseki Maeda
- Department of Palliative CareSenri‐Chuo HospitalOsakaJapan
| | - Yutaka Hatano
- Department of Palliative CareDaini Kyoritsu HospitalHyogoJapan
| | - Akari Higuchi
- Graduate School of MedicineOsaka UniversityOsakaJapan
- Department of Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Yoko Higami
- Graduate School of MedicineOsaka UniversityOsakaJapan
- Department of NursingOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | | | - Momoe Utsumi
- Graduate School of MedicineOsaka UniversityOsakaJapan
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Mori M, Kawaguchi T, Imai K, Yokomichi N, Yamaguchi T, Suzuki K, Matsunuma R, Watanabe H, Maeda I, Matsumoto Y, Matsuda Y, Morita T. Visualizing How to Use Parenteral Opioids for Terminal Cancer Dyspnea: A Pilot, Multicenter, Prospective, Observational Study. J Pain Symptom Manage 2021; 62:936-948. [PMID: 33992759 DOI: 10.1016/j.jpainsymman.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Higami Y, Higuchi A, Tanaka H, Moriki Y, Utsumi M, Yamakawa M, Ito Y, Hatano Y, Maeda I, Fukui S. Nonwearable actigraphy to assess changes in motor activity before and after rescue analgesia in terminally ill patients with cancer: A pilot study. Int J Nurs Pract 2021; 28:e13019. [PMID: 34651388 DOI: 10.1111/ijn.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/16/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to investigate the usefulness of nonwearable actigraphy to assess changes in motor activity before and after rescue analgesic administration in terminally ill cancer patients. BACKGROUND Evaluating pain in terminally ill cancer patients is difficult; pain assessment tools are needed. METHODS This was an exploratory descriptive study conducted within a palliative care unit. A nonwearable actigraph was used to measure the activity score and movement index of terminally ill patients with weeks-long prognosis and pain. The actigraph and medical data were integrated, and data were compared 6 h before and after rescue analgesic administration. RESULTS Among 10 patients (age: 75.8 ± 12.3 years; six men), we evaluated 28 pain episodes (mean activity score: 130.9 ± 180.5 counts per minute; movement index: 68.8%). When pain was relieved at night following rescue analgesic administration, activity score and movement index decreased significantly (6 h before vs. 6 h after analgesics, respectively: 113.1 to 69.7 counts per minute; 64.3% to 41.8%; both p < 0.0001). With no relief after rescue analgesic administration, activity score did not differ significantly 6 h before and after analgesics: 147.3 to 137.7 counts per minute. CONCLUSION Pain in terminally ill cancer patients could be assessed using a nonwearable actigraph to capture motor activity and improve pain assessment.
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Affiliation(s)
- Yoko Higami
- Department of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akarai Higuchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruka Tanaka
- Department of Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Yuki Moriki
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Momoe Utsumi
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Miyae Yamakawa
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Toyonaka, Osaka, Japan
| | - Sakiko Fukui
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.,Department of Health Sciences, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Mori M, Yamaguchi T, Maeda I, Hatano Y, Yamaguchi T, Imai K, Kikuchi A, Matsuda Y, Suzuki K, Tsuneto S, Hui D, Morita T. Diagnostic models for impending death in terminally ill cancer patients: A multicenter cohort study. Cancer Med 2021; 10:7988-7995. [PMID: 34586714 PMCID: PMC8607266 DOI: 10.1002/cam4.4314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/27/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background Accurately predicting impending death is essential for clinicians to clarify goals of care. We aimed to develop diagnostic models to predict death ≤3 days in cancer patients. Methods In this multicenter cohort study, we consecutively enrolled advanced cancer patients admitted to 23 inpatient hospices in 2017. Fifteen clinical signs related to impending death were documented daily from the day when the Palliative Performance Scale (PPS) declined to ≤20–14 days later. We conducted recursive partitioning analysis using the entire data set and performed cross‐validation to develop the model (prediction of 3‐day impending death‐decision tree [P3did‐DT]). Then, we summed the number of systems (nervous/cardiovascular/respiratory/musculoskeletal), where any sign was present to underpin P3did score (range = 0–4). Results Data following PPS ≤20 were obtained from 1396 of 1896 inpatients (74%). The mean age was 73 ± 12 years, and 399 (29%) had gastrointestinal tract cancer. The P3did‐DT was based on three variables and had four terminal leaves: urine output (u/o) ≤200 ml/day and decreased response to verbal stimuli, u/o ≤200 ml/day and no decreased response to verbal stimuli, u/o >200 ml/day and Richmond Agitation‐Sedation Scale (RASS) ≤−2, and u/o >200 ml/day and RASS ≥−1. The 3‐day mortality rates were 80.3%, 53.3%, 39.9%, and 20.6%, respectively (accuracy = 68.3%). In addition, 79.6%, 62.9%, 47.2%, 32.8%, and 17.4% of patients with P3did scores of 4, 3, 2, 1, and 0, respectively, died ≤3 days. Conclusion We successfully developed diagnostic models for death ≤3 days. These may further help clinicians predict impending death and help patients/families prepare for their final days.
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Affiliation(s)
| | | | | | | | | | - Kengo Imai
- Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | | | - Kozue Suzuki
- Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Bunkyo-ku, Japan
| | - Satoru Tsuneto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - David Hui
- MD Anderson Cancer Center, Houston, Texas, USA
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Shimizu Y, Hayashi A, Maeda I, Miura T, Inoue A, Takano M, Aoyama M, Matsuoka YJ, Morita T, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study. Psychooncology 2021; 31:86-97. [PMID: 34343380 PMCID: PMC9292523 DOI: 10.1002/pon.5783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
Objectives To elucidate changes in depressive symptoms after bereavement and the impact of pre‐loss resilience on such changes and on the extent of complicated grief and posttraumatic growth. Methods Prospective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereavement. Pre‐loss Connor–Davidson Resilience Scale scores, pre‐ and post‐loss Patient Health Questionnaire‐9 scores, post‐loss Brief Grief Questionnaire scores, and the expanded Posttraumatic Growth Inventory scores were determined. Results Out of 186 bereaved family caregivers, 71 (38.2%) responses were analyzed, among which 47% pre‐loss and 15% post‐loss responses suggested to be a high risk for major depressive disorder (MDD). Approximately 90% of family caregivers at a high risk for post‐loss MDD were already at a high risk for pre‐loss MDD. Even after adjustment of the background variables as covariates, the interaction effect between family caregivers' pre‐loss depressive symptoms and resilience on post‐loss depressive symptoms was observed (F = 7.29; p < 0.01). Moreover, pre‐loss resilience was not associated with other bereavement outcome measures. Conclusions Among family caregivers of patients with cancer in PCUs, 47% and 15% had high risk for MDD before and after bereavement, respectively. Moreover, pre‐loss resilience mitigated post‐loss depressive symptoms among family caregivers who had high risk for MDD before bereavement. However, considering the study's small sample size, further research is needed.
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Affiliation(s)
- Yoichi Shimizu
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan.,Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akitoshi Hayashi
- Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayuko Takano
- Department of Nursing, St. Luke's International Hospital, Tokyo, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Mori M, Kawaguchi T, Imai K, Yokomichi N, Yamaguchi T, Suzuki K, Matsunuma R, Watanabe H, Maeda I, Uehara Y, Morita T. How Successful Is Parenteral Oxycodone for Relieving Terminal Cancer Dyspnea Compared With Morphine? A Multicenter Prospective Observational Study. J Pain Symptom Manage 2021; 62:336-345. [PMID: 33290857 DOI: 10.1016/j.jpainsymman.2020.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan; Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Fukui S, Ikuta K, Maeda I, Hattori S, Hatano Y, Yamakawa M, Utsumi M, Higami Y, Tanaka H, Higuchi A. Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor. Support Care Cancer 2021; 30:77-86. [PMID: 34232391 DOI: 10.1007/s00520-021-06346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The present study aimed to explore the association between impending death and continual changes in respiratory and heart rates measured using a non-wearable monitor every minute for the final 2 weeks of life in dying cancer patients. METHODS In this longitudinal study, we enrolled patients in a palliative care unit and continuously measured their respiratory and heart rates via a monitor and additionally captured their other vital signs and clinical status from medical records. RESULT A dataset was created comprising every 24-h data collected from every-minute raw data, including information from 240 days prior to death from 24 patients (345,600 data); each patient's data were measured for 3-14 days until death. After confirming the associations between the respiratory and heat rate values on the day of death (n = 24) or other days (2-14 days before death, n = 216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24 h by univariate analyses, we conducted a repeated-measures logistic regression analysis using a generalized estimating equation. Finally, the maximum respiratory rate and mean heart rate were significantly associated with death occurring within the following 3 days (0-24 h, 0-48 h, and 0-72 h), except for the maximum respiratory rate that occurs within 0-24 h. CONCLUSION The maximum respiratory rate and mean heart rate measured every minute using a monitor can warn family caregivers and care staff, with the support of palliative care professionals, of imminent death among dying patients at home or other facilities.
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Affiliation(s)
- Sakiko Fukui
- Department of Home Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-15 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Kasumi Ikuta
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan
| | - Satoshi Hattori
- Department of Biomedical Statistics, Graduate School of Medicine, and Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, 5-28 Sakaemachi, Kawanishi, Hyogo, Japan
| | - Miyae Yamakawa
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Momoe Utsumi
- Department of Evidence-Based Nursing, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoko Higami
- Department of Nursing, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Haruka Tanaka
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Akari Higuchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Amano K, Ishiki H, Miura T, Maeda I, Hatano Y, Oyamada S, Yokomichi N, Tagami K, Odagiri T, Ito T, Baba M, Morita T, Mori M. 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; 2:122-131. [PMID: 34223511 PMCID: PMC8241396 DOI: 10.1089/pmr.2021.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer. Objectives: To investigate the relationship between serum levels of CRP and subtypes of pain. Design: A secondary cross-sectional analysis of a prospective cohort study. Setting/Subjects: Patients with advanced cancer admitted to 23 palliative care units in Japan. Measurements: 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. Results: We divided 1513 patients into four groups: low CRP (n = 234), moderate CRP (n = 513), high CRP (n = 352), and very high CRP (n = 414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (p < 0.001) and 0.16 (p < 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], p = 0.01; 1.74 [95% CI 1.18–2.57], p = 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain. Conclusions: The results indicated direct relationships between CRP, pain NRS, and pain IPOS.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Toyonaka, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, Arakawa-ku, Tokyo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Ito S, Morita T, Uneno Y, Taniyama T, Matsuda Y, Kohara H, Maeda I, Nakayama T, Mori M. Incidence and associated factors of sudden unexpected death in advanced cancer patients: A multicenter prospective cohort study. Cancer Med 2021; 10:4939-4947. [PMID: 34114364 PMCID: PMC8290229 DOI: 10.1002/cam4.4030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose A sudden unexpected death has significant negative impacts on patients, family caregivers, and medical staff in hospice/palliative care. This study aimed to clarify the incidence and associated factors of sudden unexpected death according to four definitions in advanced cancer patients. Methods We performed a prospective cohort study in 23 inpatient hospices/palliative care units in Japan. Advanced cancer patients aged ≥18 years who were admitted to inpatient hospices/palliative care units were included. The incidence and associated factors of sudden unexpected death were evaluated in all enrolled patients according to four definitions: (a) rapid decline death, defined as a sudden death preceded by functional decline over 1–2 days; (b) surprise death, defined if the primary responsible palliative care physician answered “yes” to the question, “Were you surprised by the timing of the death?”; (c) unexpected death, defined as a death that occurred earlier than the physicians had anticipated; and (d) performance status (PS)‐defined sudden death, defined as a death that occurred within 1 week of functional status assessment with an Australia‐modified Karnofsky PS ≥50. Results Among 1896 patients, the incidence of rapid decline death was the highest (30‐day cumulative incidence: 16.8%, 95% CI: 14.8–19.0%), followed by surprise death (9.6%, 8.1–11.4%), unexpected death (9.0%, 7.5–10.8%), and PS‐defined sudden death (6.4%, 5.2–8.0%). Male sex, liver metastasis, dyspnea, malignant skin lesion, and fluid retention were significantly associated with the occurrence of sudden unexpected death. Conclusion Sudden unexpected death is not uncommon even in inpatient hospices/palliative care units, with range of 6.4–16.8% according to the different definitions.
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Affiliation(s)
- Satoko Ito
- Department of Health Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | | | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Higashibata T, Hisanaga T, Hagiwara S, Shimokawa M, Yabuki R, Odagiri T, Ito T, Kamura R, Maeda I, Kosugi K, Mori M, Morita T, Tsuneto S, Hamano J. Differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units: A multicenter prospective cohort study (EASED). Palliat Med 2021; 35:799-805. [PMID: 33478365 DOI: 10.1177/0269216321989564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies on the appropriate use of urinary catheters for cancer patients at the end of life are limited. AIM To clarify the differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units. DESIGN Pre-planned secondary analysis of a multicenter, prospective cohort study; East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). SETTING/PARTICIPANTS This study enrolled consecutive advanced cancer patients admitted to palliative care units between January and December 2017. The final study group comprised 1212 patients from 21 institutions throughout Japan. RESULTS Out of the 1212 patients, 380 (31.4%; 95% confidence interval, 28.7%-34.0%) underwent urinary catheterization during their palliative care unit stay, and the prevalence of urinary catheterization in patients who died at palliative care units by institution ranged from 0.0% to 55.4%. When the 21 participating institutions were equally divided into three groups according to the institutional prevalence of catheterization, patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation were more likely to be catheterized in institutions with a high prevalence of catheterization than in those with a low or moderate prevalence (p < 0.008, p = 0.008, and p < 0.008, respectively). CONCLUSION This study revealed that the institutional prevalence of urinary catheterization in advanced cancer patients at palliative care units widely varied. Further studies are needed to establish the appropriate use of urinary catheters, especially in patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation.
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Affiliation(s)
- Takahiro Higashibata
- Palliative Care Team, Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Shingo Hagiwara
- Department of Palliative Medicine, Yuai Memorial Hospital, Koga, Japan
| | - Miho Shimokawa
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ritsuko Yabuki
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Rena Kamura
- Hospice Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Maeda I, Satomi E, Kiuchi D, Nishijima K, Matsuda Y, Tokoro A, Tagami K, Matsumoto Y, Naito A, Morita T, Iwase S, Otani H, Odagiri T, Watanabe H, Mori M, Matsuda Y, Nagaoka H, Mayuzumi M, Kanai Y, Sakamoto N, Ariyoshi K. Patient-perceived symptomatic benefits of olanzapine treatment for nausea and vomiting in patients with advanced cancer who received palliative care through consultation teams: a multicenter prospective observational study. Support Care Cancer 2021; 29:5831-5838. [PMID: 33742244 DOI: 10.1007/s00520-021-06067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the safety, effectiveness, and patient-perceived benefit of treatment with olanzapine for nausea and vomiting (N/V) in patients with advanced cancer. METHODS We conducted a multicenter prospective observational study in a tertiary care setting (Trial registration number: UMIN000020493, date of registration: 2016/1/12). We measured the following: average nausea in the last 24 h using a Numeric Rating Scale (NRS: range 0-10) at baseline and day 2, patient-perceived treatment benefit (based on a 5-point verbal scale), and adverse events (AEs; using the Common Terminology Criteria for Adverse Events version 4). RESULTS The 85 participants (45% men) had a mean age of 58.7±15.8 years. Major causes of N/V were opioids (44%) and chemotherapy (34%). All patients received a daily dose of olanzapine of 5 mg or less as first-line treatment (N=35) or second- or later-line treatment (N=50). Nausea NRS decreased from 6.1±2.2 to 1.8±2.0 (differences: -4.3, 95% CI -3.7 to -4.9, p<0.001). The proportion of patients who did not experience vomiting episodes in the last 24 h increased from 40-89%. Mean decrease in nausea NRS by patient-perceived treatment benefit were as follows: -0.8 for "none" (n=4, 5%); -2.8 for "slight" (n=17, 20%); -3.3 for "moderate" (n=14, 16%); -4.7 for "lots" (n=25, 29%); and -6.1 for "complete" (n=25, 29%; p-for-trend<0.001). The most prevalent AE was somnolence (n=15, 18%). CONCLUSION Short-term and relatively low-dose olanzapine treatment was effective for multifactorial N/V. Confirmatory studies with longer observation periods are needed to clarify the duration of the effect and adverse events.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan.
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Kaoru Nishijima
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Akemi Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Irima, Saitama, Japan
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Ikuta K, Maeda I, Hatano Y, Mori I, Fukui S. Feasibility and Clinical Usefulness of a Novel Nonwearable Sheet-Type Monitor (Nemuri SCAN): Prognostic Value of Increased Respiratory Rate in Actively Dying Patients. J Palliat Med 2021; 24:1634-1640. [PMID: 33733880 DOI: 10.1089/jpm.2020.0508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to explore the feasibility of monitoring actively dying patients hospitalized in a palliative care unit using a nonwearable sheet-type monitor that measured the state of sleep and vital signs per minute. In addition, we aimed to clarify the incidence of increased respiratory rate and its relationship with survival time. Design and Measurement: This study was conducted at a 51-bed palliative care unit in Japan from April 2018 through October 2019. Actively dying patients hospitalized in the palliative care unit were eligible to participate. Increased respiratory rate was measured by Nemuri SCAN, and patient's information was extracted from their medical records. Results: In this study, 23 patients were monitored until death; 19 patients with an observational period of 7 days or longer (163 patient days in total) were included in this analysis. There were no adverse events due to use of the nonwearable device. The cumulative incidence of increased respiratory rate (defined as more than 30 respiratory rate per minute) was 63.16% during the observational period, and the mean time between appearance of increased respiratory rate and death was 4.17 ± 4.04 days. Conclusion: This study clearly shows that hospitalized actively dying patients can be monitored using a nonwearable sheet-type monitor that measures sleeping state and vital signs per minute. Further studies are needed to utilize these noninvasive continuous monitoring devices in daily clinical practice.
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Affiliation(s)
- Kasumi Ikuta
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Ichiro Mori
- Palliative Care Surgery, Kawanishi Municipal Hospital, Kawanishi, Japan
| | - Sakiko Fukui
- Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Amano K, Maeda I, Ishiki H, Miura T, Hatano Y, Tsukuura H, Taniyama T, Matsumoto Y, Matsuda Y, Kohara H, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Yamauchi T, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Oya K, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Sakashita A, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Nakagawa J, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Hiratsuka Y, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Okizaki A, Watanabe YS, Uehara Y, Satomi E, Nishijima K, Shimoinaba J, Nakahori R, Hirohashi T, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. Effects of enteral nutrition and parenteral nutrition on survival in patients with advanced cancer cachexia: Analysis of a multicenter prospective cohort study. Clin Nutr 2021; 40:1168-1175. [DOI: 10.1016/j.clnu.2020.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
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Maeda I, Inoue S, Uemura K, Tanimukai H, Hatano Y, Yokomichi N, Amano K, Tagami K, Yoshiuchi K, Ogawa A, Iwase S. Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study. J Palliat Med 2021; 24:914-918. [PMID: 33577386 DOI: 10.1089/jpm.2020.0610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Clinical usefulness of trazodone for delirium in patients receiving palliative care is unclear. Objectives: To examine the safety and effectiveness of trazodone for delirium. Design: A secondary analysis of a multicenter prospective observational study. Setting/Subjects: The setting involves nine psycho-oncology consultation services and 14 inpatient palliative care units in Japan. Measurements: 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. Results: 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, p = 0.02]); sleep-wake cycle disturbance (p = 0.047), lability of affect (p < 0.001), and motor agitation subscales (p < 0.001) were significantly decreased. The most frequent adverse event was somnolence (n = 9). Conclusions: Low-dose trazodone treatment was generally safe and may be effective in reducing delirium severity.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Keiichi Uemura
- Department of Psychiatry, Tonan Hospital, Sapporo, Japan
| | - Hitoshi Tanimukai
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Saitama Medical University, Iruma-gun, Japan
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Yamaguchi T, Maeda I, Hatano Y, Suh SY, Cheng SY, Kim SH, Chen PJ, Morita T, Tsuneto S, Mori M. Communication and Behavior of Palliative Care Physicians of Patients With Cancer Near End of Life in Three East Asian Countries. J Pain Symptom Manage 2021; 61:315-322.e1. [PMID: 32777459 DOI: 10.1016/j.jpainsymman.2020.07.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The characteristics of physician communication with patients at the end of life (EOL) in East Asia have not been well studied. We investigated physicians' communications with imminently dying patients with cancer and their families in palliative care units (PCUs) in Japan, South Korea, and Taiwan. METHODS This observational study included patients with cancer newly admitted and deceased during their first admission to 39 PCUs in three countries. We evaluated 1) the prevalence and timing of informing patients and families of patients' impending death and 2) the prevalence of communication to assure the families of the patient's comfort. RESULTS We analyzed 2138 patients (Japan: 1633, South Korea: 256, Taiwan: 249). Fewer Japanese (4.8%: 95% confidence interval [95% CI], 3.8%-5.9%) and South Korean (19.6%: 95% CI, 15.2%-25.0%) patients were informed of their impending death, whereas 66.4% (95% CI, 60.2%-72.1%) of Taiwanese were informed; among all three countries, ≥90% of families were informed. Although most patients in all three countries and the families in South Korea and Taiwan were informed of the impending death greater than or equal to four days before death, 62.1% (95% CI, 59.6%-64.6%) of Japanese families were informed less than or equal to three days prior. Most families in all three countries received assurance that the patient would remain comfortable (could hear until death, no distress with death rattle or respiration with mandibular movement). CONCLUSIONS Physicians in Taiwan communicated about patient's impending death most frequently, and physicians in all three countries generally provided assurance to families that the patients would remain comfortable. Further studies should explore the reasons for these differences and the effects of such communications in East Asia.
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Affiliation(s)
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Suita, Japan
| | | | - Sang-Yeon Suh
- Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sun Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Ikari T, Hiratsuka Y, Yamaguchi T, Maeda I, Mori M, Uneno Y, Taniyama T, Matsuda Y, Oya K, Tagami K, Inoue A. "3-Day Surprise Question" to predict prognosis of advanced cancer patients with impending death: Multicenter prospective observational study. Cancer Med 2020; 10:1018-1026. [PMID: 33347734 PMCID: PMC7897938 DOI: 10.1002/cam4.3689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background The study aimed to clarify the efficacy of the “3‐Day Surprise Question (3DSQ)” in predicting the prognosis for advanced cancer patients with impending death. Patients and Methods This study was a part of multicenter prospective observational study which investigated the dying process in advanced cancer patients in Japan. For patients with a Palliative Performance Scale ≤20, the 3DSQ “Would I be surprised if this patient died in the next 3 days?” was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis. Results Among the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the “Not surprised” group, 636 patients died within 3 days. Among 232 (16.4%) patients of “Yes surprised” group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO2 ≥ 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected. Conclusions The 3‐Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death.
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Affiliation(s)
- Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | - Kiyofumi Oya
- Aso Iizuka Hospital, Transitional and Palliative Care, Iizuka ciyu, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Maeda I, Ogawa A, Yoshiuchi K, Akechi T, Morita T, Oyamada S, Yamaguchi T, Imai K, Sakashita A, Matsumoto Y, Uemura K, Nakahara R, Iwase S. Safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer: A large-scale multicenter prospective observational study in real-world palliative care settings. Gen Hosp Psychiatry 2020; 67:35-41. [PMID: 32950826 DOI: 10.1016/j.genhosppsych.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To clarify the safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer receiving palliative care. METHODS This was a prospective observational study involving consecutive patients with advanced cancer and delirium receiving antipsychotics in inpatient hospices or psycho-oncology settings. Adjusted mean scores of the Delirium Rating Scale Revised-98 (DRS; range: 0-39) were calculated at baseline and Day 3 using generalized estimating equations. Adverse events over 7 days were evaluated. RESULTS Data from 756 patients were analyzed (Mage = 72 ± 11 years, 62% male, 48% bedridden). The adjusted mean DRS score significantly decreased after antipsychotics administration (21.5 [95% confidence interval 19.5 to 23.4] to 20.8 [18.9 to 22.8], p = 0.03, effect size [ES] = 0.02). Significant improvement was associated with age of 75 or older (ES = 0.07), better performance status (0.32), longer estimated prognosis (0.25), psycho-oncological consultation settings (0.20), hyperactive (0.14) or mix-motor subtypes (0.24) of delirium, and quetiapine administration (0.19); significant deterioration was observed in patients with "days" prognosis (0.18). Extrapyramidal symptoms (9.8%) and somnolence (8.5%) were the most prevalent adverse events. CONCLUSIONS The use of antipsychotics as part of comprehensive delirium management was safe and may provide some symptomatic benefits for patients with terminal illness and delirium. Along with adequate non-pharmacological interventions, judicious use of antipsychotics is still recommended.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, 1-4-3 Shin-senri Higashi-machi, Toyonaka, Osaka, Japan.
| | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, Japan.
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tatsuo Akechi
- Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, Japan.
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, KS building 301, Nishi-nippori, Arakawa-ku, Tokyo, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan.
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, Japan.
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe, Hyogo, Japan.
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, Japan.
| | - Keiichi Uemura
- Department of Psychiatry, Tonan Hospital, 3-8 Kita-4jo, Nishi-7jo, Chuo-ku, Sapporo, Hokkaido, Japan.
| | - Rika Nakahara
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, 38 Moroyama-hongo, Moroyama-co, Iruma, Saitama, Japan
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Hiratsuka Y, Suh SY, Maeda I, Morita T, Mori M, Ito S, Nishi T, Hisanaga T, Iriyama T, Kaneishi K, Ikari T, Tagami K, Inoue A. Factors influencing spiritual well-being in terminally ill cancer inpatients in Japan. Support Care Cancer 2020; 29:2795-2802. [DOI: 10.1007/s00520-020-05802-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
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Amano K, Maeda I, Morita T, Masukawa K, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Beliefs and Perceptions About Parenteral Nutrition and Hydration by Family Members of Patients With Advanced Cancer Admitted to Palliative Care Units: A Nationwide Survey of Bereaved Family Members in Japan. J Pain Symptom Manage 2020; 60:355-361. [PMID: 32169541 DOI: 10.1016/j.jpainsymman.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 01/05/2023]
Abstract
CONTEXT There has been a growing consensus that parenteral nutrition and hydration is to be forgone in terminally ill patients with cancer. However, it remains unclear what the beliefs and perceptions of parenteral nutrition and hydration by the family members are. OBJECTIVES To clarify their beliefs and perceptions and examine the relationships between the factors of family members, their beliefs and perceptions, and their overall satisfaction with the care the patient received at the place of death. METHODS This study was performed as a part of the cross-sectional anonymous nationwide survey of the bereaved family members of patients with cancer in Japan. RESULTS In total, 1001 questionnaires were sent, and 610 questionnaires were returned. Among these, 499 were analyzed. Regarding the prevalence of beliefs and perceptions about parenteral nutrition and hydration, when a patient cannot eat enough, parenteral hydration is needed was the highest (87.7%), followed by the opinions of medical staff are important in the issue of parenteral nutrition and hydration, parenteral hydration serves as a substitute for oral hydration, and if I were a patient and could not eat enough, parenteral hydration would be needed (85.1%, 81.0%, and 80.0%, respectively). We extracted two concepts as follows: belief that parenteral nutrition and hydration are beneficial and perceived need for parenteral nutrition and hydration. They were not identified as independent determinants of overall care satisfaction. CONCLUSION This study showed that beliefs and perceptions about parenteral nutrition and hydration were important in the family members in palliative care.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, Osaka City General Hospital, Osaka City, Osaka, Japan.
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Toyonaka City, Osaka, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Saikyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba City, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
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Mori I, Maeda I, Morita T, Inoue S, Ikenaga M, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Watanabe H. Association Between Heart Rate and Reversibility of the Symptom, Refractoriness to Palliative Treatment, and Survival in Dyspneic Cancer Patients. J Pain Symptom Manage 2020; 60:87-93. [PMID: 32088356 DOI: 10.1016/j.jpainsymman.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
CONTEXT Dyspnea is one of the most distressing symptoms for terminally ill cancer patients and a predictor of poor prognosis. Identification of simple clinical signs, such as heart rate, indicating clinical course of each patient is of value. OBJECTIVES To explore the potential association between heart rate and reversibility of the symptom, treatment response to palliative intervention, and survival in terminally ill cancer patients with dyspnea at rest. METHODS This is a secondary analysis of a multicenter prospective cohort study of patients with advanced cancer to validate multiple prognostic tools. In the patients with dyspnea at rest at the baseline, we examined a potential association between heart rate and the reversibility of dyspnea and refractoriness to palliative treatment using logistic regression analysis. Survivals were compared using the Cox proportional hazards model among four groups with different levels of the heart rate (≤74, 75-84, 85-97, and ≥98). RESULTS A total of 2298 patients were enrolled, and 418 patients (18%) had dyspnea at rest. Reversibility of dyspnea was significantly higher in the patients with lower heart rate (P for trend = 0.008), and the refractoriness to palliative treatment tended to be higher in the patients with higher heart rate (P for trend = 0.101). The median survival for each heart rate quartile groups was significantly higher in the lower heart rate group (24 vs. 21 vs. 14 vs. 9 days; heart rate ≤74, 75-84, 85-97, and ≥98, respectively; log-rank P < 0.001). CONCLUSION Heart rate may help clinicians to make the prediction of the patient's clinical course more accurate.
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Affiliation(s)
- Ichiro Mori
- Gratia Hospital Hospice, Minoh, Osaka, Japan.
| | - Isseki Maeda
- Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka, Japan
| | - Satoshi Inoue
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka, Japan
| | - Masayuki Ikenaga
- Hospice Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka City, Japan
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Hirohashi
- Department of Palliative Care, Mitui Memorial Hospital, Chiyoda-ku, Tokyo, Japan
| | - Tsukasa Tajima
- Department of Palliative Medicine, Tohoku University Hospital, Aobaku, Sendai, Japan
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Amano K, Maeda I, Ishiki H, Miura T, Hatano Y, Oya K, Sakashita A, Ito S, Hiratsuka Y, Morita T, Mori M. Significance of fluid retention, body mass index, and weight loss in patients with advanced cancer. JCSM Clinical Reports 2020. [DOI: 10.1002/crt2.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Koji Amano
- Department of Palliative Medicine National Cancer Center Hospital 5‐1‐1 Tsukiji, Chuo‐ku Tokyo 104‐0045 Japan
- Department of Palliative and Supportive Medicine Graduate School of Medicine, Aichi Medical University 1‐1 Yazakokarimata Nagakute City Aich 480‐1195 Japan
| | - Isseki Maeda
- Department of Palliative Care Senri‐chuo Hospital Toyonaka Osaka Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine National Cancer Center Hospital 5‐1‐1 Tsukiji, Chuo‐ku Tokyo 104‐0045 Japan
| | - Tomofumi Miura
- Department of Palliative Medicine National Cancer Center Hospital East Kashiwa Chiba Japan
| | - Yutaka Hatano
- Department of Palliative Care, Kyowakai Medical Corporation Daini Kyoritsu Hospital Kawanishi Hyogo Japan
| | - Kiyofumi Oya
- Department of Palliative and Transitional Care Aso Iizuka Hospital Iizuka Fukuoka Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine Kobe University School of Medicine Kobe Hyogo Japan
| | - Satoko Ito
- Hospice The Japan Baptist Hospital Kyoto Kyoto Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine Tohoku University School of Medicine Sendai Miyagi Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division Seirei Mikatahara General Hospital Hamamatsu Shizuoka Japan
| | - Masanori Mori
- Palliative Care Team Seirei Mikatahara General Hospital Hamamatsu Shizuoka Japan
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