[The Overview of Two Programs to Support Cancer Survivor's Advocacy by CancerNet Japan].

In 2016, the Cancer Control Act was revised, with emphasis on support for people living with cancer, the public's understanding of cancer patients, continuation of employment of cancer patients and cancer education, etc, was added. In order to make policies effective, it is necessary for society to listen to the voices of cancer survivor and to know the current situation of issues they face on. We, CancerNet Japan have been supporting cancer patients through the 2 projects "Breast cancer Experienced Coordinator(BEC)Training Course", started in 2007 and "Over Cancer Together(OCT)Campaign", started in 2013. We have educated the knowledge and skills that are required for cancer survivor to utilize their experiences. There are more than 400 graduates who have completed each 2 courses. Some engaged in consultation support activities as a peer supporter in hospitals and areas, other serve as local cancer promotion committee members, and give lecture activities. These 2 projects that have supported cancer survivorship were to support the process of enhancing advocacy, cancer survivor gaining correct knowledge, standing with their own power, disseminating their own experiences and issues based on it, and taking actions to resolve.

[Agenda for dissemination of peer support by cancer survivors].

The 2012 revision of the Basic Plan to Promote Cancer Control Programs explicitly recommends the enhancement of peer support. As of October 2013, only 20% of all designated regional and prefectural core hospitals and centers for cancer care formally promote peer support. Accordingly, the national government has been organizing training courses on peer support. Even so, peer support is not readily available. CancerNet Japan, a non-profit organization, has organized a peer support system at four designated cancer care hospitals in the Kanagawa prefecture, in association with the government. Peer supporters are breast cancer survivors who have completed the"Breast Cancer Survivor Coordinator Training Program,a course organized by CancerNet Japan since 2007, and have been officially certified as coordinators after course completion. These peer supporters have not only learned from their own experience but have also studied scientific medical information on cancer. The manner in which supportive activities are conducted in these four hospitals varies according to environment; for example, a dedicated booth may be set up or a standby coordinator may be stationed in a dedicated support room. The most common issue dealt with was the fear expressed by patients or their families, and supporter responses were primarily to attentively listen to them. In this paper, we review our activities with regard to the following three areas of interest:(1) intra-institutional coordination within each hospital, (2) supporter-related issues, and (3) financial resources for efforts involved in the proposed structured peer support system to be adopted at a large number of hospitals nationwide.

[Coproductive teamwork in surgical cancer treatment].

With regard to surgical treatment of cancer, there is a strong demand for safe treatment with few errors: treatment must be based on transparency, understandability, and rationality. There is also demand for treatment which is quick, efficient and not wasteful. Rather than maintaining our current pyramidal system which has doctors standing as authorities at the top, there is a need for a flat, non-authoritarian system at every level and section of the hospital. As we change methodology, electronic medical records and clinical pathways will be important tools. Among the surgical department's treatment team in our hospital, there are many branches at work on peri-operative management aside from operations; There are teams for infection control (ICT), nutrition support (NST), decubitus and stoma management, rehabilitaion, and chemotherapy, and team cooperation after discharge from hospital. In addition, the collaborative and coproductive team focusing on pain releif and palliative care in terminal phase (PCT) is important. Having introduced each of the parts of team treatment within the setting of the surgical department, the need now for strong leadership from young and brightful surgeons is also emphasized.

Nationwide surveillance of antimicrobial susceptibility patterns of pathogens isolated from surgical site infections (SSI) in Japan.

To investigate the trends of antimicrobial resistance in pathogens isolated from surgical site infections (SSI), a Japanese surveillance committee conducted the first nationwide survey. Seven main organisms were collected from SSI at 27 medical centers in 2010 and were shipped to a central laboratory for antimicrobial susceptibility testing. A total of 702 isolates from 586 patients with SSI were included. Staphylococcus aureus (20.4 %) and Enterococcus faecalis (19.5 %) were the most common isolates, followed by Pseudomonas aeruginosa (15.4 %) and Bacteroides fragilis group (15.4 %). Methicillin-resistant S. aureus among S. aureus was 72.0 %. Vancomycin MIC 2 µg/ml strains accounted for 9.7 %. In Escherichia coli, 11 of 95 strains produced extended-spectrum ß-lactamase (Klebsiella pneumoniae, 0/53 strains). Of E. coli strains, 8.4 % were resistant to ceftazidime (CAZ) and 26.3 % to ciprofloxacin (CPFX). No P. aeruginosa strains produced metallo-ß-lactamase. In P. aeruginosa, the resistance rates were 7.4 % to tazobactam/piperacillin (TAZ/PIPC), 10.2 % to imipenem (IPM), 2.8 % to meropenem, cefepime, and CPFX, and 0 % to gentamicin. In the B. fragilis group, the rates were 28.6 % to clindamycin, 5.7 % to cefmetazole, 2.9 % to TAZ/PIPC and IPM, and 0 % to metronidazole (Bacteroides thetaiotaomicron; 59.1, 36.4, 0, 0, 0 %). MIC90 of P. aeruginosa isolated 15 days or later after surgery rose in TAZ/PIPC, CAZ, IPM, and CPFX. In patients with American Society of Anesthesiologists (ASA) score ≥3, the resistance rates of P. aeruginosa to TAZ/PIPC and CAZ were higher than in patients with ASA ≤2. The data obtained in this study revealed the trend of the spread of resistance among common species that cause SSI. Timing of isolation from surgery and the patient's physical status affected the selection of resistant organisms.

Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan.

PURPOSE: To clarify the impact of surgical site infection (SSI) after colorectal surgery on the length of hospital stay and medical expenditure in Japan. METHODS: This was a multi-center, retrospective-matched case-control study. RESULTS: The total number of patients enrolled was 334 (167 case/control pairs). The average hospital stay after surgery was prolonged by 17.8 days (95% CI 11.9-23.5) and the average medical cost after surgery was increased by $5,938 (95% CI 3,610-8,367) in the SSI group versus the non-SSI group. Hospital charges comprised the largest among all cost categories and accounted for 53% of the additional cost. The hospital stay and medical costs both increased proportionately to the depth of the SSI, from 4.4 days and $608 for superficial incisional SSI, to 39.2 days and $14,448 for organ/space SSI. SSI caused by MRSA prolonged the hospital stay by 19.3 days and incurred an additional cost of $7,015. CONCLUSIONS: SSI clearly prolonged the hospital stay and increased medical costs. The numerical values revealed by this study reinforce the medical-economic importance of instigating preventive measures against SSI.

Utility of preoperative small-bowel endoscopy for hemorrhagic lesions in the small intestine.

PURPOSE: We evaluated a small group of patients with hemorrhagic lesions in the small intestine diagnosed preoperatively by video capsule endoscopy (VCE) and/or double-balloon endoscopy (DBE), who underwent surgery in our hospital. METHODS: The subjects were 20 patients with hemorrhagic lesions in the small intestine diagnosed preoperatively by VCE and/or DBE, who underwent surgery between April 2004 and December 2008. RESULTS: VCE, DBE, and computed tomography were performed in 12, 17, and 20 patients, respectively. Eleven patients also had a biopsy taken during DBE, resulting in a definitive diagnosis in eight. Because of the risk of hemorrhage during DBE in five patients, a biopsy was not taken and the sites of the lesion were marked in these patients. Twenty patients underwent surgery, and the diagnoses were small-intestinal cancer in eight, gastrointestinal stromal tumor in seven, arteriovenous malformation in two, and Crohn's disease, angioectasia, and leiomyoma in one each. The interval between the onset of symptoms and surgery was less than 50 days for six patients, 50-100 days for two, 100-200 days for five, and more than 200 days for seven. CONCLUSION: Preoperative small-bowel endoscopy proved useful for diagnosing the cause of hemorrhagic lesions in the small intestine.

Fat replacement of the distal pancreas in a case of advanced gastric cancer.

Preoperative computed tomography in a 67-year-old man admitted with type 2 advanced gastric cancer involving the upper body of the stomach revealed marked atrophy of the left lobe of the liver and atrophy of the distal pancreas. Total gastrectomy with D2 lymph node dissection was planned; however, additional distal pancreatectomy with splenectomy was also performed during the operation because of direct invasion of the pancreas by the gastric cancer. Histopathologic examination of the resected pancreas revealed the absence of lobules, acini, conduits, and pancreatic ducts, with only islets of Langerhans found scattered in the adipose tissue. The findings revealed that the gastric cancer had directly invaded the fat, replacing the distal pancreas. In patients with fat-replaced pancreas, preoperative evaluation of direct invasion of adjacent organs/tissues by gastric cancer is difficult.

[Effectiveness of antimicrobial prophylaxis in prevention of surgical site infections].

Preventing surgical site infection (SSI) is important in providing safe and high-quality surgical care. Antimicrobial prophylaxis is given to prevent SSI. Many reports revealed that antimicrobial prophylaxis is effective to reduce SSI rates, when its initial dose is given at proper timing and additional dose is properly given in longer operations. Initial dose of antimicrobial prophylaxis is recommended to be administered within one hour before starting operation. Additional dose is recommended to be administered each two to three hours in longer operations. Antimicrobial prophylaxis should be given according to pharmacokinetics/pharmacodynamics (PK/PD). Beta-lactam drugs are recommended to be administered three or four times a day to obtain longer time above MIC and effective antimicrobial activity. In United States, Surgical Care Improvement Project (SCIP) is ongoing to reduce complications after surgery. Proper usage of antimicrobial prophylaxis is strongly recommended to reduce SSI in this project. Surgical team hopes to reduce SSI by proper administration of antimicrobial prophylaxis with the cooperatiing of anesthesiologists and operating room staffs.

[Risk management and postoperative infection control].

Review of nine cases of judicial precedent on the issue of the postoperative infection in Japan indicates the following issues: indication of surgery; violation of informed consent; preventive measures against nosocomial infection during the preoperative period; cleanliness control during surgery; and treatment of postoperative infection. The most important yardstick for judgment is whether the provided treatment is conformed to the level of standard medical treatment available at the time. Therefore, we should be well versed in the standard postoperative infection treatment, particularly infection surveillance data and CDC standard precautions and related guidelines. Moreover, in each hospital, an infection control team should play an important role in infection control and prevention through preparing manuals and clinical paths incorporating precautions to ensure that the whole staff comply with the prescribed procedures.

[Importance of the primary physician for pain management in patients with recurrent advanced cancer--a questionnaire survey].

With the objective of clarifying points that needed improvement to provide earlier and better treatment of pain by assessing the current state of cancer pain management in Japan, we conducted a questionnaire survey about pain management in patients with advanced/recurrent cancer who were suffering from pain. The results of the survey revealed that it is important for primary physician to place greater emphasis on pain management when treating cancer patients, to inform patients that the doctor should always be told if the patient has pain, and provide appropriate information about medical narcotics to their patients. The team approach to management of cancer has been increasing in importance recently. This survey suggested it is important for primary physicians, who play a central role in such teams, to listen to their patients' complaints about symptoms including pain. Furthermore, it should be remembered that patients are eager to establish a good, trusting relationship with their primary physician.

[Pathological complete response in an elderly patient with locally advanced gastric cancer treated with S-1/CDDP].

We report a patient with locally advanced gastric carcinoma successfully treated with S-1/CDDP. The patient was a 77-year-old woman who had gastric cancer surgically diagnosed as T4N2, invading the pancreas and mesocolon. After the firsts exploratory laparotomy, chemotherapy was begun as follows. S-1(80 mg/day)was orally administered for 3 weeks followed by 2 weeks' rest as a course, and CDDP(75 mg/body)was administered by intravenous drip on day 8. Because of severe anorexia and nausea, however, the CDDP administration had to be discontinued. Therefore, we changed the procedure to S-1 single treatments, 2 weeks' administration followed by 2 weeks' rest. The total 9 courses of this procedure proved successful. Subsequently, she underwent curative surgery consisting of total gastrectomy with D2 lymph node dissection, combined with distal pancreatectomy and splenectomy, and obtained pathological CR. S-1/CDDP appears to be an effective treatment modality for advanced gastric cancer.

Sialoglycoconjugate expression in primary colorectal cancer and metastatic lymph node tissues.

BACKGROUND/AIMS: Aberrant cell surface glycosylation, and especially excessive sialylation, is thought to have great importance in tumor malignancy. To investigate the clinicopathological significance of sialylation in colorectal cancer, we performed histochemical analyses using sialic acid-binding lectins. METHODOLOGY: Primary colorectal cancer and lymph node tissues obtained from 80 cases were subjected to lectin-immunohistochemical staining using Maackia amurensis leukoagglutinin (MAL) and Sambucus nigra agglutinin (SNA). The relationship between the staining characteristics and the various clinicopathological parameters was statistically analyzed. RESULTS: In primary cancer tissues, a high level of SNA staining was significantly related to worse prognosis and some pathological characteristics such as lymph node metastasis, whereas a high level of MAL staining was related to worse prognosis. In metastatic lymph node tissues, positive staining was frequently found for MAL and SNA, which wasremarkable in cases categorized as N2 metastasis. Furthermore, cases with MAL-positive staining in metastatic lymph node tissues evidently indicated worse prognosis than those with MAL-negative staining. CONCLUSIONS: Aberrant expression of SNA-positive sialoglycoconjugates in primary colorectal cancer tissues is important in terms of unfavorable pathological characteristics of the cancer. In addition, aberrant expression of MAL-positive sialoglycoconjugates in metastatic lymph node tissues might be related to worse prognosis.

Clinical significance of subcellular localization of KL-6 mucin in primary colorectal adenocarcinoma and metastatic tissues.

AIM: To assess subcellular localization of KL-6 mucin and its clinicopathological significance in colorectal carcinoma as well as metastatic lymph node and liver tissues. METHODS: Colorectal carcinoma tissues as well as metastatic lymph node and liver tissues were collected from 82 patients who underwent colorectomy or hepatectomy. Tissues were subjected to immunohistochemical analysis using KL-6 antibody. RESULTS: Of the 82 colorectal carcinoma patients, 6 showed no staining, 29 showed positive staining only in the apical membrane, and 47 showed positive staining in the circumferential membrane and/or cytoplasm. Positive staining was not observed in non-cancerous colorectal epithelial cells surrounding the tumor tissues. The five-year survival rate was significantly lower in cases showing positive staining in the circumferential membrane and/or cytoplasm (63.0%) than those showing positive staining only in the apical membrane (85.7%) and those showing no staining (100%). Statistical analysis between clinicopathological factors and subcellular localization of KL-6 mucin showed that KL-6 localization in the circumferential membrane and/or cytoplasm was significantly associated with the presence of venous invasion (P = 0.0003), lymphatic invasion (P<0.0001), lymph node metastasis (P<0.0001), liver metastasis (P = 0.058), and advanced histological stage (P<0.0001). Positive staining was observed in all metastatic lesions tested as well as in the primary colorectal carcinoma tissues. CONCLUSION: The subcellular staining pattern of KL-6 in colorectal adenocarcinoma may be an important indicator for unfavorable behaviors such as lymph node and liver metastasis, as well as for the prognosis of patients.