[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.

Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance.

PURPOSE: This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost. METHODS: A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI. RESULTS: Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery. Overall, the mean post-operative hospitalization was 20.7 days longer and the mean post-operative healthcare expenditure was $8,791 higher in the SSI group than for the SSI-free group. Among the patients who had undergone abdominal surgery, development of SSI extended the average hospitalization by 17.6 days and increased the average healthcare expenditure by $6,624. Among the patients who had undergone cardiac surgery, SSI extended the post-operative hospitalization by an average of 48.9 days and increased the post-operative healthcare expenditure by an average of $28,534. CONCLUSIONS: Under the current healthcare system in Japan, the development of SSI after abdominal surgery necessitates extension of hospitalization two-fold and increases the post-operative healthcare expenditure 2.5-fold. Development of SSI after cardiac surgery necessitates extension of hospitalization fourfold and increases the healthcare expenditure six-fold.

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.

Sustained aberrant localization of KL-6 mucin and beta-catenin at the invasion front of human gastric cancer cells.

AIMS: This study sought to analyze the clinicopathological significance of KL-6 mucin, a type of MUC1, in gastric cancer and its relationship to ß-catenin. PATIENTS AND METHODS: Subcellular localization of KL-6 mucin and ß-catenin in gastric cancer tissues (n = 96) was detected immunohistochemically and its clinicopathological significance was evaluated. RESULTS: Samples with localization of KL-6 mucin in the surrounding membrane and/or cytoplasm of cancer cells at the invasion front (n = 50, 52%) had a higher incidence of deeper invasion (p < 0.0001), lymphatic vessel invasion (p = 0.0003), venous invasion (p < 0.0001), lymph node metastasis (p < 0.0001) and an advanced TNM stage (p = 0.0005). Furthermore, this localization of KL-6 mucin was associated with accumulated nuclear localization of ß-catenin. CONCLUSION: In concert with aberrant localization of ß-catenin, sustained localization of KL-6 mucin in the surrounding membrane and/or cytoplasm of cancer cells at the invasion front has a significant role in cancer progression.

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.

[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.