Effect of mycalolides isolated from a marine sponge Mycale aff. nullarosette on actin in living cells.

Discovery of novel bioactive compounds is important not only for therapeutic purposes but also for understanding the mechanisms of biological processes. To screen bioactive compounds that affect nuclear morphology in marine organism extracts, we employed a microscopy-based assay using DNA staining of human cancer cells. A crude extract from a marine sponge Mycale aff. nullarosette, collected from the east coast of Japan, induced cellular binucleation. Fractionation of the extract led to the isolation of mycalolides A and B, and 38-hydroxymycalolide B as the active components. Mycalolides have been identified as marine toxins that induce depolymerization of the actin filament. Live cell imaging revealed that low concentrations of mycalolide A produce binucleated cells by inhibiting the completion of cytokinesis. At higher concentrations, however, mycalolide A causes immediate disruption of actin filaments and changes in cell morphology, yielding rounded cells. These results suggest that the completion of cytokinesis is a process requiring high actin polymerization activity. Furthermore, luciferase reporter assays with mycalolide A treatments support the view that the level of globular actin can affect transcription of a serum response gene.

The number of CD34+CD133+ hematopoietic stem cells residing in umbilical cord blood (UCB) units is not correlated with the numbers of total nucleated cells and CD34+ cells: a possible new indicator for quality evaluation of UCB units.

Umbilical cord blood transplantation (UCBT) is often associated with delayed neutrophil and platelet recovery. Engraftment failure is another major obstacle. Several factors influence these serious complications, including the numbers of total nucleated cells (TNCs) and CD34+ cells which have been used as reliable factors for selecting UCB units for transplantation. However, whether both factors are reliable indices of the hematopoietic stem cell (HSC) activity of UCB units remains unknown. To evaluate the quality of UCB units, we quantified the actual number of transplantable CD34+CD133+ HSCs (tHSCs) residing in UCB units. The number of tHSCs was not correlated with the numbers of TNCs or CD34+ cells. These results strongly suggest that neither factor reflects the numbers of tHSCs residing in UCB units. To validate the significance of the number of tHSCs, further analysis is required to determine whether the number of tHSCs residing in UCB units is useful as a new indicator for the quality assessment of UCB units.

Kakeromamide A, a new cyclic pentapeptide inducing astrocyte differentiation isolated from the marine cyanobacterium Moorea bouillonii.

Kakeromamide A (1), a new cyclic pentapeptide encompassing a thiazole ring moiety and a ß-amino acid, was isolated from the marine cyanobacterium Moorea bouillonii. Its structure was elucidated by the spectral analysis and the modified Marfey's method. Compound 1 induced differentiation of neural stem cells into astrocytes at the concentration of 10 µM.

Halistanol sulfates I and J, new SIRT1-3 inhibitory steroid sulfates from a marine sponge of the genus Halichondria.

Two new analogs of halistanol sulfate (1) were isolated from a marine sponge Halichondria sp. collected at Hachijo-jima Island. Structures of these new halistanol sulfates I (2) and J (3) were elucidated by spectral analyses. Compounds 1-3 showed inhibitory activity against SIRT 1-3 with IC50 ranges of 45.9-67.9, 18.9-21.1 and 21.8-37.5 µM, respectively. X-ray crystallography of the halistanol sulfate (1) and SIRT3 complex clearly indicates that 1 binds to the exosite of SIRT3 that we have discovered in this study.

Cancer in adolescents and young adults: National incidence and characteristics in Japan.

OBJECTIVE: Adolescents and young adults (AYA) with cancer are confronted with unique challenges in areas of paramount concern within their age group, such as fertility, education, career, and delayed and long-term effects of treatment. However, the extent and depth of the problem has never been examined in the Japanese population. The aim of this study was to describe the status of cancer patients in the AYA population, using data from the hospital-based cancer registry (HBCR). STUDY DESIGN: Patients included in the HBCR from January 2011 to December 2014 were included in this study to evaluate the incidence and cancer distribution trends among AYA. The total number and the proportion of AYA (15-39 years of age) stratified by sex, age, and cancer type were obtained. The incidence of age-specific cancer among AYA was also calculated. RESULTS: We identified 30,394 male (35.1%) and 56,100 female (64.9%) cancer patients in the population, which collectively constituted about 3% of all invasive cancer cases. The incidence of cancer in AYA was estimated as 86.2 per 100,000 per year, and increased with age. The most affected population was women between 35 and 39 years of age (35%). Breast cancer was the most common type of cancer, followed by cervical, uterine, and thyroid cancers. CONCLUSION: A substantial number of AYA are diagnosed with cancer every year. The distribution of cancer types in AYA was dependent on age and sex. These diversities in cancer types can inform researchers and policy makers to fine-tune their studies and policies.

Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study.

BACKGROUND: Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. METHODS: Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. Consistency and validity were examined using correlation coefficients and factorial analysis. RESULTS: The CSC score (median, 14; interquartile range, 11-18) varied according to hospital volume. The five subcategories showed moderate consistency (Cronbach's α = 0.765). A strong correlation existed between types of available personnel and specific expertise. Using the 2011 Japanese Diagnosis Procedure Combination database for patients hospitalized with stroke, four constructs were identified by factorial analysis (neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care and rehabilitation) that affected in-hospital mortality from ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The total CSC score was related to in-hospital mortality from ischemic stroke (odds ratio [OR], 0.973; 95% confidence interval [CI], 0.958-0.989), intracerebral hemorrhage (OR, 0.970; 95% CI, 0.950-0.990), and subarachnoid hemorrhage (OR, 0.951; 95% CI, 0.925-0.977), with varying contributions from the four constructs. CONCLUSIONS: The CSC score is a valid measure for assessing CSC capabilities, based on the availability of neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and critical care and rehabilitation services.

Prescription of Prophylactic Antiemetic Drugs for Patients Receiving Chemotherapy With Minimal and Low Emetic Risk.

IMPORTANCE: The use of antiemetic drugs for patients receiving chemotherapy with low or minimal emetic risk has been recognized as a growing concern for health care costs and patients' welfare. Relatively few studies have examined antiemetic prophylaxis or treatment of emesis associated with chemotherapy with lower emetic risk. OBJECTIVE: To describe the pattern in Japan of overprescribing prophylactic antiemetic drugs to patients who have received intravenous chemotherapy with minimal or low emetic risk. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a health insurance claims database linked with the hospital-based cancer registry of 122 designated cancer care hospitals covered the period from September 1, 2010, to December 31, 2012. Data were included from patients who (1) were diagnosed with breast, lung, colorectal, stomach, cervical, or prostate cancer; (2) were 20 years or older at the time of the diagnosis; and (3) received intravenous chemotherapy with minimal or low emetic risk. The data from patients with advanced stage cancer (stage IV) were excluded. Data were analyzed from March 20, 2014, to June 30, 2016. MAIN OUTCOMES AND MEASURES: The percentage of chemotherapy administration involving patients prescribed prophylactic antiemetic drugs, namely, a neurokinin 1 receptor antagonist, serotonin receptor antagonist, and/or dexamethasone, was calculated. The costs of potentially unnecessary antiemetic drugs were estimated using the National Health Insurance drug price list for 2011. RESULTS: A total of 8545 patients (5886 women [68.9%] and 2659 men [31.1%]; mean [SD] age, 61.9 [12.8] years) undergoing 73 577 administrations of chemotherapy with minimal emetic risk (2464 patients; 22 619 administrations) or low emetic risk (6081 patients; 50 958 administrations) were identified. Of these, patients who received 24 373 administrations of chemotherapy with a low emetic risk (47.8%) and 633 administrations of chemotherapy with a minimal emetic risk (2.8%) were prescribed serotonin receptor antagonists and dexamethasone. Outpatients in the low emetic risk group underwent more frequent administration of chemotherapy that included prescription of both drugs (53.1% of the chemotherapy; 95% CI, 51.6%-54.7%) compared with inpatients (33.7% of the chemotherapy; 95% CI, 31.7%-35.9%). Consequently, approximately ¥170 million (US $1.6 million) was unnecessarily spent on prophylactic antiemetic drugs for these patients. CONCLUSIONS AND RELEVANCE: A substantial number of patients receiving chemotherapy with minimal and low emetic risk were prescribed potentially unnecessary prophylactic antiemetic drugs. The judicious use of these drugs could spare the burden of extra costs and the potential risk for adverse effects for patients.

Association between novel arterial stiffness indices and risk factors of cardiovascular disease.

BACKGROUND: Prevention and early detection of arterial stiffness are required to avoid severe cardiovascular events. Recently, new noninvasive arterial stiffness indices, the arterial pressure volume index (API) and the arterial velocity pulse index (AVI), have been developed. The purpose of this study was to examine the clinical validity of these new indices by investigating the association between known risk factors of cardiovascular disease (CVD) and API or AVI in a large population. METHODS: This cross-sectional survey included 7248 adults who underwent an annual medical checkup at a single medical institution. API and AVI were measured using cuff oscillometry by trained nurses. We used correlation coefficients, t-tests, and multiple regression analyses to evaluate associations, and calculated intraclass correlation coefficients (ICC) to examine test-retest reliabilities of these indices. RESULTS: Mean age was 45.5 years (SD = 5.8), and 4083 (56.3 %) participants were men, while 3165 were women. Mean values of API and AVI were 25.1 (SD = 7.0) and 16.6 (SD = 5.4), respectively. API was strongly correlated with body mass index (BMI), systolic blood pressure (sBP), and diastolic blood pressure (dBP) (r > 0.3, p < 0.001). AVI was strongly correlated with age, sBP, and API (r > 0.3, p < 0.001). Multiple regression analyses showed that sex, age, BMI, and sBP were independently associated with API. Sex, age, BMI, sBP, fasting plasma glucose (FPG), and smoking condition were also independently associated with AVI. As reliabilities of measurements, the ICC of API was 0.74, and the ICC of AVI was 0.80. CONCLUSIONS: These new noninvasive arterial stiffness indices, which had high test-retest reliabilities, were associated with known risk factors of CVD. Further study is warranted to determine the clinical validity of these indices.

Risk of Alcohol Consumption in Bladder Cancer: Case-Control Study from a Nationwide Inpatient Database in Japan.

Bladder cancer is common in Western countries, but not in Japan. Established risk factors are smoking and high-risk jobs such as printing and manufacturing. The risk of alcohol consumption in bladder cancer has been the recent focus; however, available literature on alcohol consumption and bladder cancer has been limited from Japanese population, thought to have a weak genetic tolerance to acetaldehyde. We aimed to determine whether alcohol consumption is an independent risk factor for bladder cancer among Japanese. The study was a matched case-control study from the nationwide Japanese clinical database administered by the Rosai Hospital group. We identified 739 cases of bladder cancer diagnosed between 2005 (when the database was established) and 2014 and 7,196 controls matched by sex, age, hospital, and admission period. We estimated the odds ratio of alcohol consumption for bladder cancer adjusted for the amount of smoking, high-risk occupations, and comorbidities (hypertension, hyperlipidemia, diabetes, hyperuricemia, and obesity) with conditional logistic regression. The risk of bladder cancer was significantly higher in ever drinkers than in never drinkers (odds ratio, 1.33; 95% confidence interval, 1.06 to 1.66). Furthermore, the risk threshold for alcohol consumption was more than 15 g of alcohol intake per day (one, 180-mL cup equivalent to 6 ounces of Japanese sake containing 23 grams of alcohol). Among Japanese, alcohol consumption may be an independent risk factor for bladder cancer, with a lower risk threshold.

Influence of Differently Licensed KIR2DL1-Positive Natural Killer Cells in Transplant Recipients with Acute Leukemia: A Japanese National Registry Study.

Licensing by self MHC class I ligands is required for proper natural killer (NK) cell response. NK cells with inhibitory killer cell immunoglobulin-like receptors for nonself MHC exhibit transient alloreactivity after hematopoietic stem cell transplantation (HSCT). We analyzed 3866 recipients in the Japan national registry who underwent their first allogeneic HSCT for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) from HLA-A, -B, and -DRB1 allele-genomatched unrelated donors. By classifying them into 5 independent groups based on HLA-C group matching and assumed donor NK cell status, we found that for HLA-C-matched HSCT for AML in HLA-C1/C1 recipients, in whom transient alloreactivity against HLA-C2-negative leukemic cells was expected, the relapse rate was significantly lower than it was in HLA-C-matched HSCT for AML in HLA-C1/C2 recipients (hazard ratio [HR], .72; P = .011). This difference was not observed in HLA-C-matched HSCT for ALL. Compared with HLA-C-matched HSCT, significantly higher mortality was observed in HLA-C1/C1 AML patients who received transplants from HLA-C-mismatched HLA-C1/C1 donors (HR, 1.37; P = .001) and in HLA-C1/C1 ALL patients who received transplants from HLA-C2-positive donors (HR, 2.13; P = .005). In conclusion, donor selection based on leukemic subtype and donor HLA-C group matching improves transplantation outcome after HLA-C-mismatched HSCT.

Monitoring and evaluating the quality of cancer care in Japan using administrative claims data.

The importance of measuring the quality of cancer care has been well recognized in many developed countries, but has never been successfully implemented on a national level in Japan. We sought to establish a wide-scale quality monitoring and evaluation program for cancer by measuring 13 process-of-care quality indicators (QI) using a registry-linked claims database. We measured two QI on pre-treatment testing, nine on adherence to clinical guidelines on therapeutic treatments, and two on supportive care, for breast, prostate, colorectal, stomach, lung, liver and cervical cancer patients who were diagnosed in 2011 from 178 hospitals. We further assessed the reasons for non-adherence for patients who did not receive the indicated care in 26 hospitals. QI for pretreatment testing were high in most hospitals (above 80%), but scores on adjuvant radiation and chemoradiation therapies were low (20-37%), except for breast cancer (74%). QI for adjuvant chemotherapy and supportive care were more widely distributed across hospitals (45-68%). Further analysis in 26 hospitals showed that most of the patients who did not receive adjuvant chemotherapy had clinically valid reasons for not receiving the specified care (above 70%), but the majority of the patients did not have sufficient reasons for not receiving adjuvant radiotherapy (52-69%) and supportive care (above 80%). We present here the first wide-scale quality measurement initiative of cancer patients in Japan. Patients without clinically valid reasons for non-adherence should be examined further in future to improve care.

Patterns of prescribing radiotherapy and bevacizumab in nationwide practice - analysis of 101 designated cancer care hospitals in Japan.

Radiotherapy and bevacizumab are each effective in treating patients with advanced cancer, but their concurrent use may cause serious adverse events (SAEs). Whereas sequential administration can theoretically reduce the risk of SAEs while maintaining the anticancer effects, this hypothesis remains unconfirmed, leading to variations in practice. To elucidate current practices, the patterns of care received by patients in Japan with regard to these two therapies were assessed in a large database of a hospital-based cancer registry linked with insurance claims. This database contained information on 106 057 patients diagnosed with seven major cancers in 2011 and the care they received up to the end of 2012. In total, 335 patients from 101 hospitals in the database were treated with both radiotherapy and bevacizumab. Of these patients, 50.8% had lung cancer, and 51.3% had Stage IV cancer. Of the 335 patients, 75 (22.4%) received these therapies concurrently. In patients treated sequentially, the time from the last dose of bevacizumab to the start of radiotherapy was most frequently 4-5 weeks (12.4%), whereas the time from the end of radiotherapy to the start of bevacizumab was most frequently 1-2 weeks (10.6%). The cumulative proportions of patients in these two groups receiving sequential therapies within 3 weeks were 19.0% and 26.1%, respectively. Many practices appeared to avoid the concurrent use of bevacizumab and radiation, but some provided concurrent therapy. Additional data are required to determine whether the avoidance of concurrent use should become a standard of care.

Are hospitals in Japan with larger patient volume treating younger and earlier-stage cancer patients? An analysis of hospital-based cancer registry data in Japan.

OBJECTIVE: Differences in hospital case-mix have not been adequately accounted for in hospital volume and patient outcome studies in Japan. We aimed to examine whether differences may exist by investigating the distribution of patients' stage and age across designated cancer treatment hospitals of varying patient volume across Japan. METHODS: We analyzed data of gastric, breast, colorectal, lung and liver cancer patients who were included in the national database of hospital-based cancer registries between 2008 and 2011. We investigated the association between hospital volume, cancer stage and patient age. Hospitals were classified into five groups according to patient volume. RESULTS: In total, 676 713 patients met the inclusion criteria. The proportion of patients with early-stage (tumor-node-metastasis Stage 0 or I) cancer was higher among high-volume hospitals for all cancer types except small cell lung cancer. The proportion of older patients (age >75 years) was smaller among high-volume hospitals for all cancer types. The difference in the proportion of patients with early-stage cancers between very low-volume and very high-volume hospitals was greatest for non-small cell lung cancer (26.5% for very low and 43.5% for very high). This difference for the proportion of older patients was also greatest for non-small cell lung cancer (48.9% for very low and 30.3% for very high). CONCLUSIONS: We showed that the proportions of early-stage cancer patients and younger patients are greater in higher-volume hospitals compared with lower-volume hospitals in Japan. Researchers conducting volume-outcome studies and policymakers analyzing hospital performance should be cautious when making interhospital comparisons.

[Cancer treatment situation in Japan with regard to the type of medical facility using medical claim data of Health Insurance Societies].

OBJECTIVES: Analyzing the cancer treatment situation in Japan is an important public health issue, especially because of increasing crude cancer morbidity in a rapidly aging society. This study aimed to examine where cancer patients received treatment, with special attention to designated regional cancer hospitals, and the treatment modality they received. METHODS: Using health insurance claim data (1,064,875 subjects on December 2011) managed by the Japan Medical Data Center, we included patients that received treatments for stomach, colon, liver, lung, or breast cancer, the most common cancers in Japan, between 2005 and 2011. We divided the medical facilities where they were treated into five groups: prefectural designated regional cancer hospitals, local designated regional cancer hospitals, large/medium hospitals (≥100 beds), small hospitals (20-99 beds), and clinics (0-19 beds). We calculated the percentage of patients treated at each type of medical facility with different treatment modalities. RESULTS: The study included 2,901 patients. In total, 43.9% patients were treated at designated regional cancer hospitals (prefectural or local). This percentage was the highest for lung cancer (60.0%) and the lowest for colon cancer (31.3%). Surgeries for liver cancer (67.6%) and lung cancer (61.9%) were performed more at designated regional cancer hospitals (prefectural or local) than surgeries for stomach cancer (45.5%), colon cancer (40.1%), and breast cancer (49.8%). Some procedures were performed at small hospitals or clinics (surgery for stomach cancer [9.4%], surgery for breast cancer [9.3%], endoscopic procedures for stomach cancer [14.1%] and colon cancer [40.6%], and chemotherapy for breast cancer [11.4%]). Colon and breast cancer patients treated at prefectural designated regional cancer hospitals or clinics were younger than those treated at other types of facilities. CONCLUSION: The distribution of facilities at which cancer patients received treatment differed significantly according to cancer site, treatment modality, and patient age.

A cross sectional study on fertility knowledge in Japan, measured with the Japanese version of Cardiff Fertility Knowledge Scale (CFKS-J).

BACKGROUND: A recent survey of 79 countries showed that fertility knowledge was lower in Japan than in any other developed country. Given the fertility decline in Japan and the importance of fertility knowledge, we conducted an online survey to examine fertility knowledge and the related factors for effective public education. METHODS: We studied people aged 18-59 years old, n = 4,328 (the "General" group), and also people who had been trying to conceive for at least six months, 18-50 years old, n = 618 (the "Triers" group). Fertility knowledge was assessed using the Japanese version of the 13-item Cardiff Fertility Knowledge Scale (CFKS-J). All participants provided socio-demographic and fertility information. Participants also completed a 14-item health literacy scale and an 11-item health numeracy scale. We asked participants who were aware of age-related decline in fertility when and where they first acquired that knowledge. RESULTS: The average percentages of CFKS-J items answered correctly were 53.1% in the Triers group and 44.4% in the General group (p < 0.001). Multivariate linear regression models showed in the Triers group greater fertility knowledge was associated with greater health literacy and prior medical consultation regarding their fertility. In the General group greater fertility knowledge was associated with being female, younger, university educated, currently trying to conceive, non-smoking, having higher household income, having higher health literacy and having higher health numeracy. Of those who were aware of the age-related decline in fertility, around 3% first learned the fact "at school", and around 65% first learned it "through mass media" or "via the Internet". More than 30% of the respondents first learned it "less than 5 years before" the survey. CONCLUSIONS: Although fertility knowledge had improved since a previous study, possibly due to recent media coverage of age-related infertility, it was still low. Educational interventions, both in schools and in the community, may be needed to increase fertility knowledge in the general population because most people obtain fertility knowledge from mass media, which has been shown to often present distorted and inaccurate fertility information.

Sex differences in bladder cancer pathology and survival: analysis of a population-based cancer registry.

Sex differences in bladder cancer pathology and epidemiology have been the focus of recent research. We investigated the epidemiological characteristics and compared bladder cancer pathology and survival between men and women in Japan. A total of 13,184 patients with primary bladder cancer diagnosed from 1954 to 2010 were identified in a large-scale cancer registry database in Kanagawa Prefecture. Using this database, we compared the odds ratios (ORs) for nonurothelial carcinoma (non-UC) using a multiple logistic regression model adjusted for age and diagnosis periods. We also compared hazard ratios (HRs) for overall death and cancer-specific death using a Cox proportional hazards model adjusted for non-UC, age, and diagnosis period. The proportion of non-UC was significantly higher in female compared with male patients (OR = 2.14, 95% confidence interval [CI]: 1.81-2.52). Furthermore, survival was significantly poorer in female patients than in male patients after adjusting for UC or non-UC (HR for overall death = 1.15, 95% CI: 1.06-1.23; HR for cancer-specific death = 1.39, 95% CI: 1.28-1.52). Sex differences exist in the epidemiological characteristics of bladder cancer in Japan, with female patients having less favorable pathology and poorer survival compared with male patients.

Estimated life expectancy and risk of death from cancer by quartiles in the older Japanese population: 2010 vital statistics.

Data on life expectancies and risk of death from cancer are essential information to have when making informed decisions about cancer screening and treatment options, but has never been presented in a way that is readily available to use for physicians in Japan. We provided estimates of life expectancies and predicted risk of death from seven most common types of cancer (lung, gastric, liver, colon, prostate, breast, and cervical) by quartiles for the older Japanese population above 50 years old, using 2010 life tables and cancer mortality statistics data. We found that there was a large difference in life expectancy between older persons in the upper and lower quartiles. Risk of death from breast cancer was low. By using this data, physicians can more accurately obtain life expectancy estimates by assessing which quartile the patient is most likely to fall under, and help patients make better informed decisions.

Understanding by the general public of newspaper reports on publicly reported cancer survival in Japan: a randomized controlled trial.

OBJECTIVE: This study was aimed to examine how well readers of newspapers understand cancer survival rate data, and the effect of this understanding on their behavioral intent. METHODS: We recruited 1950 persons who were 20 years old or older registered with a market research company. Participants were randomly divided into 10 groups; 9 were assigned one of nine newspaper articles, and the remaining group was assigned the excerpt of the official Association of Clinical Cancer Centers web pages. The primary outcome was the proportion of respondents with 'sufficient understanding', who gave 70% or more correct answers on a 10-item knowledge question. RESULTS: The proportion of participants with sufficient understanding varied across the groups (range: 0.8-22.1%, overall, P<0.001). Only around 15% of participants answered that they would consider other hospitals in a scenario where the only hospital in the participants' area had a 5-year survival of 5% or less, and answers did not significantly vary between groups (range: 11.1-21.0%, overall P=0.77). CONCLUSIONS: The level of understanding of cancer survival rate varied by variation in media reporting. However, the effect of behavioral intent on hospital choice did not differ between articles. TRIAL REGISTRATION: UMIN CTR UMIN000004885.

Prescription trends of prophylactic antiemetics for chemotherapy-induced nausea and vomiting in Japan.

PURPOSE: This study aimed at identifying prescription trends for the recommended antiemetic therapies before and after the publication of the first guidelines for antiemetic therapy in Japan. METHODS: Claims data of 20 Japanese health insurance societies were analyzed. Claims for patients 18 years old or older who received chemotherapy with high or moderate emetic risk were extracted. The rate of patients who were prescribed the recommended antiemetic drugs was calculated. RESULTS: From 2005 to 2011, prescriptions for prophylactic antiemetics increased. These prescriptions included the three-drug combination (an NK1 antagonist, a 5-HT3 antagonist, and a corticosteroid) and the two-drug combination (a 5-HT3 antagonist and a corticosteroid). For chemotherapy patients with high emetic risk, these prescriptions increased from 81.1 to 95.5%. For those with moderate emetic risk, these prescriptions increased from 78.5 to 89.9%. After approval of an NK1 antagonist at the end of 2009, the prescription rate for the three-drug combination increased from 37.0% in 2010 to 60.1% in 2011 in the high emetic risk group. CONCLUSION: A gradual increasing trend was identified in the rate of prescribing antiemetic drugs from 2005 to 2011. This trend was observed in insurance claims data from a wide variety of health-care providers. However, only 60.1% patients of the high emetic risk group received the recommended three-drug combination in 2011. Further research will be useful to evaluate patients' experiences with their chemotherapy and the effectiveness of the prophylactic antiemetic therapy for cancer treatment and patients' quality of life.

The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.