RESUMO
The integration of standard oncology and palliative care has become common around the world. Since the proposal of this approach by ASCO in the late 1990s, and studies by Temel, et al on EBM using RCT in 2010, and by Kaasa, et al at the Lancet Oncology Commission in 2018, it seems that most of the world agrees. Today, there are increasing expectations that comprehensive cancer care should be carried out by a multidisciplinary team. However, this has been challenging due to significant ideological differences between cancer treatment based on natural science and palliative care, which is mainly based on social science. From this, the idea of"palliative oncology"developed, which is built on the premise that palliative care should exist as a science derived from symptomatic treatment. Therefore, clinical oncologists should provide palliative care to enable better integration in cancer care.
Assuntos
Neoplasias , Cuidados Paliativos , Humanos , Oncologia , Neoplasias/terapiaRESUMO
BACKGROUND: The purpose of this study was to detect background factors that might be associated with the therapeutic and curative outcome of chemotherapy in elderly cancer patients aged over 75 years. METHODS: A retrospective study was conducted for elderly cancer patients aged over 75 years who had received more than 2 courses of chemotherapy at our hospital. We analyzed the relationships between RECIST outcome and background factors, such as age, sex, clinical TNM stage, pre-treatment history, ECOG performance status, serum albumin, and Charlson comorbidity index using logistic regression analysis. RESULTS: A total of 103 cancer patients aged over 75 years were analyzed in this study, including 28 with hematological neoplasia, 36 with gastrointestinal tract cancers, 25 with breast cancers, and 14 with other malignancies originating in various tissues. Seventy-one patients (69.1%) had a positive clinical outcome including RECIST CR (complete response), PR (partial response) and SD (stable disease). Multivariate analysis showed that a high serum albumin level of more than 3.5 g/dl and a Charlson comorbidity index score of less than 2 points were positively correlated with a favorable therapeutic outcome. CONCLUSIONS: The results of the current study suggested that serum albumin level and comorbidity index are the principal clinical factors affecting therapeutic outcomes in elderly cancer patients receiving chemotherapy. In the future, these factors may make chemotherapy adaptations, continuity, and effectiveness easier to predict than GA screening.
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Neoplasias/tratamento farmacológico , Albumina Sérica Humana/análise , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Comorbidade , Feminino , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/epidemiologia , Humanos , Masculino , Neoplasias/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Collusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research. METHOD: Situations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG. RESULT: 1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion. SIGNIFICANCE OF RESULTS: This case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.
Assuntos
Cuidados Paliativos/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/tendências , Estudos RetrospectivosRESUMO
PURPOSE: The recommended dosing interval for transdermal fentanyl is every 72 h. However, some patients will have "end-of-dose failure," which may be seen as an increase of episodes of severe pain flares at the third day after application of the patch. A new once-a-day fentanyl patch was developed in Japan since 2010. This study aimed to assess the efficacy of the once-a-day fentanyl citrate patch for patients with cancer-related pain receiving the 72-h transdermal fentanyl not lasting 72 h. METHODS: We performed a cross-sectional retrospective analysis of 445 inpatients with the 72-h transdermal fentanyl at Higashi Sapporo Hospital. We could switch to the once-a-day fentanyl citrate patch if patients reported inadequate pain relief beyond 48 h after application of the 72-h transdermal fentanyl. Patients recorded baseline scores for background pain intensity (PI) and the frequency of use of daily rescue medication for breakthrough cancer pain (BTcP). RESULTS: Of all patients, 10.1% showed the increase in PI of 30% or more baseline PI on the third day after application of the 72-h transdermal fentanyl. Of patients, 84.4% were converted from equivalent dose of the 72-h transdermal fentanyl to the once-a-day fentanyl citrate patch. On the third day after switching, 60.5% of patients showed a reduction of more than 30% from baseline PI. Switching to the once-a-day fentanyl citrate patch significantly reduced the mean frequency of daily rescue dose for BTcP. CONCLUSIONS: A once-a-day fentanyl citrate patch provided stable pain control. Its use may be considered as the dominant strategy for patients receiving a 72-h transdermal fentanyl not lasting 72 h.
Assuntos
Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Fentanila/uso terapêutico , Neoplasias/tratamento farmacológico , Administração Cutânea , Idoso , Analgésicos Opioides/administração & dosagem , Estudos Transversais , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adesivo TransdérmicoRESUMO
BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is difficult to manage. A phase III trial conducted in the United States demonstrated that duloxetine was effective for CIPN caused by taxane and platinum-based chemotherapy. No randomized trial of duloxetine for CIPN has been conducted in Japan. METHODS: In this open-label, randomized, crossover study, eligible patients were randomized to Group A or Group B. Group A received duloxetine 20 mg/day orally for the first week and 40 mg/day for the next 3 weeks. Group B received vitamin B12 (VB12) 1.5 mg/day orally for 4 weeks. After a 2- to 4-week washout period, treatment was crossed over for another 4 weeks. The severity of numbness and pain was assessed using a visual analog scale (VAS). RESULTS: Thirty-four patients were enrolled. Obvious decreases in the mean VAS scores for numbness and pain were observed for the periods of duloxetine administration. Significant differences were observed between the duloxetine-first (Group A) and the VB12-first (Group B) groups with respect to numbness (p = 0.03) and pain (p = 0.04) at 4 weeks after administration. Fatigue was observed in six of the 34 participants (17.6 %). CONCLUSIONS: Our data suggests that duloxetine has a beneficial effect on CIPN caused by oxaliplatin, paclitaxel, vincristine, or bortezomib in Japanese patients.
Assuntos
Antineoplásicos/efeitos adversos , Cloridrato de Duloxetina/uso terapêutico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Idoso , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/prevenção & controle , Projetos Piloto , Vitamina B 12/uso terapêuticoRESUMO
OBJECTIVE: Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU). METHODS: We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011. Continuous deep sedation can only be administered safely and appropriately when a multidisciplinary team is involved in the decision-making process. Prior to administration of CDS, a multidisciplinary team conference (MDTC) was held with respect to all the patients considered for CDS by an attending physician. The main outcome measures were the frequency and characteristics of CDS (patient background, all target symptoms, medications used for sedation, duration, family's satisfaction, and distress). We mailed anonymous questionnaires to bereaved families in August 2011. RESULTS: Of 1581 deceased patients, 22 (1.39%) had received CDS. Physical exhaustion 8 (36.4%), dyspnea 7 (31.8%), and pain 5 (22.7%) were the most frequently mentioned indications. Continuous deep sedation had a duration of less than 1 week in 17 (77.3%). Six patients (0.38%) did not meet the appropriate criteria for CDS according to the MDTC and so did not receive it. Although bereaved families were generally comfortable with the practice of CDS, some expressed a high level of emotional distress. SIGNIFICANCE OF RESULTS: Our results indicate that the prevalence of CDS will be decreased when it is carried out solely for appropriate indications. Continuity of teamwork, good coordination, exchange of information, and communication between the various care providers are essential. A lack of any of these may lead to inadequate assessment, information discrepancies, and unrest.
Assuntos
Tomada de Decisões , Sedação Profunda , Família/psicologia , Neoplasias/psicologia , Manejo da Dor/métodos , Dor Intratável/tratamento farmacológico , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente , Assistência Terminal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Cancer stem-like cells (CSCs) and tumor-initiating cells (TICs) are a small population of cancer cells that share three properties: tumor initiating ability, self-renewal, and differentiation. These properties suggest that CSCs/TICs are essential for tumor maintenance, recurrence, and distant metastasis. Here, we show that cytotoxic T lymphocytes (CTLs) specific for the tumor-associated antigen CEP55 can efficiently recognize colon CSCs/TICs both in vitro and in vivo. Using Hoechst 33342 dye staining, we isolated CSCs/TICs as side population (SP) cells from colon cancer cell lines SW480, HT29, and HCT15. The SP cells expressed high levels of the stem cell markers SOX2, POU5F1, LGR5, and ALDH1A1 and showed resistance to chemotherapeutic agents such as irinotecan or etoposide.To evaluate the susceptibility of SP cells to CTLs, we used CTL clone 41, which is specific for the CEP55-derived antigenic peptide Cep55/c10orf3_193 (10) (VYVKGLLAKI). The SP cells expressed HLA class I and CEP55 at the same level as the main population cells. The SP cells were susceptible to CTL clone 41 at the same level as main population cells. Furthermore, adoptive transfer of CTL clone 41 inhibited tumor growth of SW480 SP cells in vivo. These observations suggest that Cep55/c10orf3_193(10) peptide-based cancer vaccine therapy or adoptive cell transfer of the CTL clone is a possible approach for targeting chemotherapy-resistant colon CSCs/TICs.
Assuntos
Neoplasias do Colo/imunologia , Células-Tronco Neoplásicas/imunologia , Linfócitos T Citotóxicos/citologia , Animais , Antígenos/química , Antineoplásicos/farmacologia , Benzimidazóis/farmacologia , Camptotecina/análogos & derivados , Camptotecina/farmacologia , Linhagem Celular Tumoral , Etoposídeo/farmacologia , Humanos , Irinotecano , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Transplante de Neoplasias , Peptídeos/químicaRESUMO
Considerable individual differences have been widely observed in the sensitivity to opioids. We conducted a genome-wide association study (GWAS) in patients with cancer pain to identify potential candidate single-nucleotide polymorphisms (SNPs) that contribute to individual differences in opioid analgesic requirements in pain treatment by utilizing whole-genome genotyping arrays with more than 650,000 markers. The subjects in the GWAS were 428 patients who provided written informed consent and underwent treatment for pain with opioid analgesics in a palliative care unit at Higashi-Sapporo Hospital. The GWAS showed two intronic SNPs, rs1283671 and rs1283720, in the ANGPT1 gene that encodes a secreted glycoprotein that belongs to the angiopoietin family. These two SNPs were strongly associated with average daily opioid requirements for the treatment of pain in both the additive and recessive models (p < 5.0000 × 10−8). Several other SNPs were also significantly associated with the phenotype. In the gene-based analysis, the association was significant for the SLC2A14 gene in the additive model. These results indicate that these SNPs could serve as markers that predict the efficacy of opioid analgesics in cancer pain treatment. Our findings may provide valuable information for achieving satisfactory pain control and open new avenues for personalized pain treatment.
RESUMO
In our previous study, we demonstrated that a peptide derived from the novel centrosome residing protein Cep55/c10orf3 can be targeted by the cytotoxic T lymphocytes (CTLs) in peripheral blood mononuclear cells (PBMCs) of breast carcinoma patients. In this report, we evaluated the feasibility of cancer immunotherapy using Cep55/c10orf3 peptide for colorectal carcinoma (CRC). To evaluate the expression of Cep55/c10orf3 in CRC tissues, we performed immunohistochemical staining of using anti-Cep55/c10orf3 monoclonal antibody. Sixty-three percent cases showed weak positive for Cep55/c10orf3 in total 70 CRC cases. The Cep55/c10orf3 expression intention was collated with high histological grade of CRC. Thus, we hypothesized that Cep55/c10orf3 can also be the target of CTLs in CRC cases. We generated CTLs from PBMCs of human leukocyte antigen (HLA)-A24-positive colorectal carcinoma patients using HLA-A24-restricted Cep55/c10orf3 peptides. Two of 6 colorectal cancer patients were reactive for the Cep55/c10orf3_193(10) peptide, which was the only immunogenic peptide in breast carcinoma patients. CTL clone specific for Cep55/c10orf3_193(10) recognized and lysed HLA-A24 (+) and Cep55/c10orf3 (+) colorectal carcinoma cell lines. In addition, 1 of 6 colorectal carcinoma patients was reactive for the Cep55/c10orf3_402(11) and Cep55/c10orf3_283(12) peptides, but not for Cep55/c10orf3_193(10) with the ELISPOT assay. These observations suggest that the antigenic peptide repertoire presented by HLA-A24 in colorectal carcinoma might be different from that in breast carcinoma. Thus, these peptide vaccination peptide mixture of Cep55/c10orf3_193(10), Cep55/c10orf3_402(11) and Cep55/c10orf3_283(12) might be more effective than a single peptide in the treatment of colorectal carcinoma patients.
Assuntos
Vacinas Anticâncer/uso terapêutico , Proteínas de Ciclo Celular/imunologia , Neoplasias Colorretais/terapia , Proteínas Nucleares/imunologia , Peptídeos/imunologia , Vacinas de Subunidades Antigênicas/uso terapêutico , Proteínas de Ciclo Celular/metabolismo , Linhagem Celular Tumoral , Neoplasias Colorretais/imunologia , Estudos de Viabilidade , Feminino , Antígenos HLA-A/imunologia , Antígenos HLA-A/metabolismo , Antígeno HLA-A24 , Humanos , Proteínas Nucleares/metabolismo , Peptídeos/metabolismo , Linfócitos T Citotóxicos/imunologia , Linfócitos T Citotóxicos/metabolismo , Vacinas de Subunidades Antigênicas/imunologiaRESUMO
OBJECTIVE: Hormonal imbalance characterized by excessive production of growth hormone (GH) and a low circulating concentration of insulin-like growth factor (IGF)-1 has been demonstrated in individuals with various serious conditions. However, little is known about changes in the GH-IGF-1 axis in cancer patients. METHODS: We prospectively examined the circulating levels of several hormones in 58 patients with solid tumors who were classified according to Eastern Cooperative Oncology Group performance status (PS): PS 0-1, n = 15; PS 2, n = 15; PS 3, n = 15; and PS 4, n = 13. The relations of hormone concentrations, with a focus on the GH-IGF-1 system, to PS were evaluated by Spearman's rank correlation test and regression analysis. RESULTS: The circulating levels of IGF-1, IGF-binding protein-3 and thyroid hormones (total T(3) and T(4)) were inversely correlated with PS score. The concentration of GH was increased irrespective of PS but not statistically significant. The ratio of IGF-I to GH was inversely correlated with PS. The levels of GH and IGF-1 in all patients were also inversely correlated. CONCLUSIONS: The present study suggests that the GH-IGF-1 axis is disturbed in patients with cancer.
Assuntos
Biomarcadores Tumorais/sangue , Hormônio do Crescimento Humano/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Neoplasias/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Prognóstico , Estudos Prospectivos , Radioimunoensaio , Taxa de Sobrevida , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
The institutional review board of our hospital approved FLAG-MG therapy (G-CSF 300 microg day 1-6, fludarabin 30 mg/m(2) day 2-6, Ara-C 1 g/m(2) day 2-6, mitoxantrone 5 mg/m(2) day 2-4, gemtuzumab ozogamicin 3 mg/m(2) day 9) for relapsed or refractory elderly acute myeloid leukemia patients. We conducted this therapy for two refractory patients aged 56 and 63 and one relapsed 58-year-old patient. All three patients were induced complete remission after FLAG-MG therapy without serious complications.
Assuntos
Aminoglicosídeos/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Citarabina/administração & dosagem , Esquema de Medicação , Feminino , Gemtuzumab , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mitoxantrona/administração & dosagem , Recidiva , Indução de Remissão , Vidarabina/administração & dosagem , Vidarabina/análogos & derivadosRESUMO
Colorectal cancer consists of a small number of cancer stem cells (CSC) and many non-CSCs. Although rare in number, CSCs are a target for cancer therapy, because they survive conventional chemo- and radiotherapies and perpetuate tumor formation in vivo In this study, we conducted an HLA ligandome analysis to survey HLA-A24 peptides displayed by CSCs and non-CSCs of colorectal cancer. The analysis identified an antigen, ASB4, which was processed and presented by a CSC subset but not by non-CSCs. The ASB4 gene was expressed in CSCs of colorectal cancer, but not in cells that had differentiated into non-CSCs. Because ASB4 was not expressed by normal tissues, its peptide epitope elicited CD8+ cytotoxic T-cell (CTL) responses, which lysed CSCs of colorectal cancer and left non-CSCs intact. Therefore, ASB4 is a tumor-associated antigen that can elicit CTL responses specific to CSCs and can discriminate between two cellular subsets of colorectal cancer. Adoptively transferred CTLs specific for the CSC antigen ASB4 could infiltrate implanted colorectal cancer cell tumors and effectively prevented tumor growth in a mouse model. As the cancer cells implanted in these mice contained very few CSCs, the elimination of a CSC subset could be the condition necessary and sufficient to control tumor formation in vivo These results suggest that CTL-based immunotherapies against colorectal CSCs might be useful for preventing relapses. Cancer Immunol Res; 6(3); 358-69. ©2018 AACR.
Assuntos
Antígenos de Neoplasias/imunologia , Neoplasias Colorretais/terapia , Imunoterapia , Células-Tronco Neoplásicas/imunologia , Proteínas Supressoras da Sinalização de Citocina/imunologia , Linfócitos T Citotóxicos/imunologia , Animais , Linhagem Celular Tumoral , Humanos , CamundongosRESUMO
A 49-year-old man was admitted with high-grade fever, night sweating and cervical lymphadenopathy in September 2005. On examination, both neutrophilia and thrombocytosis were noted in the peripheral blood, a bone marrow examination revealed marked both myeloid and megakaryocytic hyperplasia. The sera obtained at initial presentation showed an elevated levels of granulocyte-colony stimulating factor (G-CSF) and interleukin-6 (IL-6). A pathologic diagnosis of T-cell rich B-cell lymphoma was made based on an inguinal lymph node biopsy. Following treatment with CHOP accompanied by rituximab (R-CHOP), both the neutrophilia and thrombocytosis subsided after 3 courses of R-CHOP, resulting in a complete remission after 4 courses of chemotherapy. Neutrophilia, thrombocytosis and T-cell rich B-cell lymphoma in this patient were considerably ameliorated with chemotherapy. We report here a patient with T-cell rich B-cell lymphoma associated with both neutrophilia and thrombocytosis, suggesting that the lymphoma triggered both myeloid and megakaryocytic hyperplasia.
Assuntos
Leucocitose/etiologia , Linfoma de Células B/complicações , Neutrófilos , Linfócitos T , Trombocitose/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/sangue , Humanos , Hiperplasia , Interleucina-6/sangue , Contagem de Linfócitos , Linfoma de Células B/diagnóstico , Linfoma de Células B/tratamento farmacológico , Linfoma de Células B/patologia , Masculino , Megacariócitos/patologia , Pessoa de Meia-Idade , Células Mieloides/patologia , Resultado do TratamentoRESUMO
A 75-year-old man was admitted to our hospital in October, 2005 for examination of pre-diagnosed pancytopenia. His bone marrow showed myeloid dysplasia, and 30.4% of the nucleated cells were blasts. Our diagnosis was acute myelogenous leukemia with multilineage myelodysplasia (AML with MLD; WHO classification). A direct Coombs test proved positive, and the platelet-associated IgG (PA-IgG) level was elevated. After treatment with CAG (Ara-C + ACR + G-CSF), complete remission was obtained, showing negative on the direct Coombs test with PA-IgG levels returned to normal. The patient subsequently relapsed, testing positive on the direct Coombs test and experiencing a re-elevation of PA-IgG levels. We report here a first case of AML with MLD, direct Coombs test and PA-IgG assay.
Assuntos
Plaquetas/imunologia , Teste de Coombs , Imunoglobulina G/sangue , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/diagnóstico , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/diagnóstico , Aclarubicina/administração & dosagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citarabina/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Humanos , Leucemia Mieloide Aguda/sangue , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/tratamento farmacológico , Pancitopenia/etiologia , Prednisolona/administração & dosagem , Resultado do TratamentoRESUMO
Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, unreflected behaviors, and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for both, patient and clinician. After an introductory definition of collusion, two archetypal situations of collusion-based on material from a regular supervision of a palliative care specialist by a liaison psychiatrist-and means of working through collusion are presented. The theoretical framework of collusion is then described and the conceptual shortcomings of the palliative care literature in this respect discussed, justifying the call for more clarity. Finally, cultural aspects and societal injunctions on the dying, contributing to the development of collusion in end-of-life care, are discussed.
Assuntos
Relações Médico-Paciente , Assistência Terminal , Idoso , Atitude Frente a Morte , Comunicação , Cultura , Humanos , Masculino , Pessoa de Meia-Idade , Especialização , Transferência Psicológica , Inconsciente PsicológicoRESUMO
BACKGROUND: Various drugs are administered for the management of chemotherapy-induced peripheral neuropathy (CIPN) in Japan. However, there have been no surveys undertaken to identify these drugs or their frequency of prescription. Therefore, we administered a questionnaire survey to the diplomates of the Subspecialty Board of Japanese Society of Medical Oncology (JSMO) to investigate the frequency of administration of different drugs for the management of CIPN in Japan. METHODS: We investigated the use of vitamin B12, antiepileptic agents such as pregabalin, duloxetine, antidepressants other than duloxetine, non-steroidal anti-inflammatory drugs (NSAIDs), opioids and the Kampo compound goshajinkigan in a questionnaire employing a three-step scale wherein A implies routine or prophylactic administration, B implies occasional administration and C implies infrequent administration. RESULTS: Considering responses A and B together, the most frequently administered drugs for the treatment of numbness were antiepileptic drugs such as pregabalin (A+B=98.7%), vitamin B12 (74.7%), Kampo compounds (58.7%) and duloxetine (46.8%). The most frequently prescribed drugs for pain were NSAIDs (97.7%), followed by opioids (83.1%) and finally antiepileptic drugs (82.1%). CONCLUSIONS: Various drugs are frequently administered for CIPN. In addition, it was found that marked differences exist between the drugs targeted on numbness and pain.
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PURPOSE: Cancer-initiating cells (CICs) are thought to be essential for tumor maintenance, recurrence, and distant metastasis, and they are therefore reasonable targets for cancer therapy. Cancer immunotherapy is a novel approach to target cancer. In this study, we aimed to establish novel CIC-targeting immunotherapy. EXPERIMENTAL DESIGN: Colorectal cancer (CRC) CICs were isolated as side population (SP) cells. The gene expression profile of CRC CICs was analyzed by cDNA microarray and RT-PCR. Protein expression of olfactory receptor family 7 subfamily C member 1 (OR7C1) were analyzed by Western blot and immunohistochemical staining. The functions of OR7C1 were analyzed by gene overexpression and gene knockdown using siRNAs. OR7C1-positive cells were isolated by a flow cytometer and analyzed. CTLs specific for OR7C1 peptide were generated, and the antitumor effect was addressed by mice adoptive transfer model. RESULTS: OR7C1 has essential roles in the maintenance of colon CICs, and the OR7C1-positive population showed higher tumorigenicity than that of the OR7C1-negative population, indicating that OR7C1 is a novel functional marker for colon CIC. Immunohistochemical staining revealed that OR7C1 high expression was correlated with poorer prognosis in CRC patients. OR7C1-derived antigenic peptide-specific CTLs showed specific cytotoxicity for CICs, and an OR7C1-specific CTL clone showed a greater antitumor effect than did a CTL clone targeting all cancer cells in a CTL adoptive transfer mouse model. CONCLUSIONS: OR7C1 is a novel marker for colon CICs and can be a target of potent CIC-targeting immunotherapy. Clin Cancer Res; 22(13); 3298-309. ©2016 AACR.
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Adenocarcinoma/terapia , Biomarcadores Tumorais/imunologia , Neoplasias do Colo/terapia , Imunoterapia/métodos , Células-Tronco Neoplásicas/imunologia , Receptores Odorantes/imunologia , Linfócitos T Citotóxicos/imunologia , Adenocarcinoma/imunologia , Adenocarcinoma/patologia , Animais , Biomarcadores Tumorais/biossíntese , Biomarcadores Tumorais/genética , Neoplasias do Colo/imunologia , Neoplasias do Colo/patologia , Células HT29 , Humanos , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Prognóstico , Interferência de RNA , RNA Interferente Pequeno/genética , Receptores Odorantes/biossíntese , Receptores Odorantes/genética , Esferoides Celulares , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter. CPB was performed within 2-3 days after the control measurement. The VAS scores of the patients receiving CPB (n = 10) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the standard NSAID-morphine treatment (n = 11) during the same time period after the control measurement. Morphine consumption was significantly lower in weeks 4-7 (inclusive) following the procedure in the CPB group and continued to be lower thereafter, though not significantly so. Although the PS score slightly improved at the 2nd week after CPB, it was not improved by the start of the NSAID-morphine treatment. Self-assessed QOL scores did not ameliorate statistically after CPB; however, they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods, while they deteriorated only slightly in the CPB group. There were fewer side effects after CPB. These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain, but it may prevent deterioration in QOL by the long-lasting analgesic effect, limitation of side effects and the reduction of morphine consumption, compared to treatment only with NSAID-morphine.
Assuntos
Analgésicos Opioides/uso terapêutico , Plexo Celíaco , Morfina/uso terapêutico , Bloqueio Nervoso , Manejo da Dor , Neoplasias Pancreáticas/complicações , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Morfina/administração & dosagem , Morfina/efeitos adversos , Dor/tratamento farmacológico , Dor/psicologia , Medição da Dor , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for terminally ill cancer patients. Some studies have demonstrated that appropriate hydration can contribute to patient comfort; however, few studies have examined the effects of volume reduction on patient symptoms and quality of life (QOL). OBJECTIVE: This study aimed to clarify the effects of reducing the volume of artificial hydration based on the Japanese guideline in terminally ill cancer patients with hydration-related symptoms on the alleviation of various symptoms and QOL. METHODS: Of the 273 terminally ill cancer patients who were transferred from other hospitals for palliative care over the last 2 years, 78 patients who presented with hydration-related symptoms at the time of admission were analyzed. We performed guideline-based AHT and reduced the volume of hydration with standard pharmacological therapy. The effects on the alleviation of hydration-related symptoms and QOL were examined using a numeric rating scale and item 30 of the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (EORTC QLQ-C30) to compare values measured before and one week after AHT. We also evaluated patient satisfaction and the feeling of benefit from hydration one week after the study commenced. RESULTS: Hydration-related symptoms (nausea, 16 cases; abdominal pain/distention, 22 cases; peripheral edema, 32 cases; and dyspnea, 15 cases) were significantly improved after performing guideline-based AHT (p=0.024, p=0.003, p<0.0001, and p=0.046, respectively). General QOL scores, global satisfaction, and feeling of benefit were also significantly improved after performing guideline-based AHT (p<0.0001, p=0.0001, and p=0.001, respectively). CONCLUSIONS: The provision of appropriate guideline-based AHT can contribute to alleviating hydration-related symptoms and improving QOL in terminally ill cancer patients.
Assuntos
Desidratação/terapia , Hidratação/efeitos adversos , Neoplasias/terapia , Cuidados Paliativos , Qualidade de Vida , Assistência Terminal/normas , Doente Terminal , Idoso , Feminino , Humanos , Japão , Satisfação do Paciente , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Higashi Sapporo Hospital is a cancer-specific hospital with palliative care doctors and certified oncologists. During case conferences held twice a week, we routinely evaluate the referred patients. In our case conferences, we selected patients who were referred to our palliative care division from other hospitals, with possible indications for cancer chemotherapies. We reviewed a total of 1215 patients who were referred to our palliative care division. We identified 18 cases as having indications for cancer chemotherapies. Among them, we identified 4 cases as having indications for standard cancer chemotherapies. All 4 patients tolerated the therapies well, responded to chemotherapy, and survived for more than 1 year. Conferences in which oncologists and palliative care doctors can discuss cases frequently and intimately are thought to be important.