Comprehensive geriatric assessment as a useful tool in predicting adverse events in elderly patients with diffuse large B-cell lymphoma.

We conducted a multicenter prospective study on whether a comprehensive geriatric assessment (CGA) can predict the adverse events (AEs) of chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL). Patients aged ≥ 65 years with newly diagnosed DLBCL underwent a pretreatment baseline CGA consisting of six assessment tools: activities of daily living (ADL), instrumental ADL (IADL), mood, nutritional status, comorbidities, and cognitive function. An attending physician chose each patient's treatment but was blind to CGA results. Patients were grouped as "dependent" or "independent" according to the CGA. The primary endpoint was to evaluate the association between chemotherapy-induced grade 3-4 toxicity and CGA. Of 86 patients, 78 completed the designated CGA. The median age was 79 years (65-89). Seventy-two patients were treated with a cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP-like) regimen, and six were treated with low-toxicity regimens. Forty-one patients were classified as dependent and 37 as independent. In multivariate analysis, an impairment of IADL was independently associated with grade 3-4 leukopenia (odds ratio [OR] 0.63; 95% confidence interval [CI] 0.43-0.92, p = 0.017) and anemia (OR 0.67; 95% CI 0.50-0.90, p = 0.008). The presence of a comorbidity was also associated with grade 3-4 non-hematological toxicity (OR 2.17; 95% CI 1.37-3.43, p = 0.001). The 4-year survival rate tended to be longer in the independent (72.7%) compared to dependent (56.9%) group. Overall, a CGA may be a useful tool for predicting serious AEs associated with chemotherapy in elderly patients with DLBCL.

[Management system of cancer chemotherapy regimens].

Cancer chemotherapy regimens which had been used at a ward and outpatient chemotherapy in various departments were collected and made available to everybody in October, 2003. However, it was difficult to manage cancer chemotherapy regimens in real time, from the viewpoint of risk management. Then, the Cancer Chemotherapy Center took the leading part and established a chemotherapy exploratory committee, which consists of 4 doctors, 2 nurses and 2 pharmacists, in June, 2006. The department of pharmacy could control all cancer chemotherapy regimens by this system, and lead the proper use of increasing anticancer agents. Inquiries on prescription by the pharmacist contributed to proper medical treatment. The role of the cancer chemotherapy exploratory committee and its outcome are described for the purpose of the prevention of medical accidents in this paper.

[Risk assessment for outpatients for cancer chemotherapy].

Outpatient treatment in the cancer chemotherapy center was begun in April 2005 at the University of Occupational and Environmental Health Hospital. Drugs were prescribed 2,590 times during the past year. Times for intravenous drip for various regimens and outpatient chemotherapy desired by patients showed a rough. The number of incidents was three (0.12%) and no accidents occurred. There were 74 consultations with pharmacists about prescriptions (2.6%) and 286 (11.0%) with nurses. Both types of consultation decreased and their contents were different. The number of consultations about prescriptions by special staff at the cancer chemotherapy center was less than at other departments. Therefore, a system assuring safe management is critically required for the establishment of a system for outpatient cancer chemotherapy treatment.

[A medical economic benefit of outpatient with cancer chemotherapy].

Recently, there is a worldwide tendency to decrease medical costs, and a medical insurance revolution, such as a diagnosis procedure combination system, has also been put forward in Japan. It is important to consider medical management healthily by shortening hospital stays and cutting the cost of admission therapies. In this background, outpatients' chemotherapy takes notice because of the improvement in quality of life, discovery of new drugs without severe adverse effects, use-effectiveness of hospital beds and medical cost-effectiveness. Cancer patients suffer from not only a major burden of the diseases such as their physical and mental state, but also an economic impact. In this article, we review the medical cost-benefit for outpatients undergoing cancer chemotherapy.