Temporal Profiles of Symptom Scores After Palliative Radiotherapy for Bleeding Gastric Cancer With Adjustment for the Palliative Prognostic Index: An Exploratory Analysis of a Multicentre Prospective Observational Study (JROSG 17-3).

AIMS: Although palliative radiotherapy for gastric cancer may improve some symptoms, it may also have a negative impact due to its toxicity. We investigated whether symptoms improved after radiotherapy with adjustment for the Palliative Prognostic Index (PPI) considering that patients with limited survival tend to experience deterioration of symptoms. MATERIALS AND METHODS: This study was an exploratory analysis of the Japanese Radiation Oncology Study Group study (JROSG 17-3). We assessed six symptom scores (nausea, anorexia, fatigue, shortness of breath, pain at the irradiated area and distress) at registration and 2, 4 and 8 weeks thereafter. We tested whether symptoms linearly improved after adjusting for the baseline PPI. Shared parameter models were used to adjust for potential bias in missing data. RESULTS: The present study analysed all 55 patients enrolled in JROSG 17-3. With time from registration as the only explanatory variable in the model, a significant linear decrease was observed in shortness of breath, pain and distress (slopes, -0.26, -0.22 and -0.19, respectively). Given that the interaction terms (i.e. PPI × time) were not significantly associated with symptom scores in any of the six symptoms, only PPI was included as the main effect in the final multivariable models. After adjusting for the PPI, shortness of breath, pain and distress significantly improved (slope, -0.25, -0.19 and -0.17; P < 0.001, 0.002 and 0.047, respectively). An improvement in fatigue and distress was observed only in patients treated with a biologically effective dose ≤14.4 Gy. CONCLUSION: Shortness of breath, pain and distress improved after radiotherapy. Moreover, a higher PPI was significantly associated with higher symptom scores at all time points, including baseline. In contrast, PPI did not seem to influence the improvement of these symptoms. Regardless of the expected survival, patients receiving radiotherapy for gastric cancer can expect an improvement in shortness of breath, pain and distress over 8 weeks. Multiple-fraction radiotherapy might hamper the improvement in fatigue and distress by its toxicity or treatment burden.

[Recent spread of home parenteral nutrition in Japan--the view of an HPN managing company].

Terumo Corporation has developed a nation wide home healthcare management system "Home-Joint," which helps hospitals to safely discharge patients early. Recently, this system mainly has been adopted with HPN (home parenteral nutrition) patients. This report evaluates 472 HPN patients who underwent the "Home-Joint" program in 1998, and also presents some issues from the standpoint of a HPN managing company. I. Profiles of HPN patients Number: 472 (female 43%, male 57%) Age: 1-104 (47% patients over 70) DIAGNOSIS: cancer 54%, others 25%, unknown 21% Infusion devices: ambulatory pump 85%, stationary pump 15%, gravity none. Therapeutic periods: average 65.6 days (1-437) for 300 patients who completed the program. II. HPN trends from 1997 to 1998 1. Increase in patients directly supported by hospitals. 2. Wider patient variation: increase in patients under 70 years old, in non-cancer patients and in longer periods (longer than 2 months). III. Issues 1. Development of hospital-clinic-pharmacy local relationship. 2. Development of devices for easier infusion control. 3. Evaluation of HPN outcome for patients' QOL and for cost-effectiveness. HPN is becoming a popular home healthcare therapy in Japan, and it requires higher level of performance by medical staff and managing companies.