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1.
Jpn J Clin Oncol ; 51(7): 1094-1099, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989400

RESUMO

OBJECTIVE: This survey was conducted to clarify the current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan. METHODS: A survey questionnaire was sent to 427 designated cancer hospitals in Japan. Information was sought regarding whether inpatient cancer rehabilitation was provided by the center, and if so, whether respondents regarded such provision as satisfactory. RESULTS: Responses were obtained from 235/427 surveyed institutions (55.0%). Cancer rehabilitation was provided in inpatient settings by 97.4%. Two-thirds of respondents (67.7%) regarded inpatient cancer rehabilitation provision as still inadequate. The primary reasons claimed for this inadequacy were a lack of human resources, a lack of rehabilitation professionals with the requisite knowledge/skills and patients who would benefit from cancer rehabilitation present but not prescribed. The total number of rehabilitation staff was identified as associated factor of inadequate inpatient cancer rehabilitation in multivariate analysis (odds ratio = 0.979, 95% confidence interval = 0.96-1.00, P = 0.009). CONCLUSIONS: In order to provide adequate cancer rehabilitation, a sufficient supply of rehabilitation staff, education and recognition of the need for cancer rehabilitation within oncology units are necessary.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Neoplasias/reabilitação , Humanos , Japão , Recursos Humanos em Hospital , Qualidade da Assistência à Saúde , Inquéritos e Questionários
2.
Surg Today ; 51(7): 1135-1143, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33491103

RESUMO

PURPOSE: It is known that sarcopenia affects the overall short- and long-term outcomes of patients with gastric cancer (GC); however, the effect of muscle quality on infectious complications after gastrectomy for GC remains unclear. We investigated the associations between the preoperative quantity and quality of skeletal muscle on infectious complications following gastrectomy for GC. METHODS: The subjects of this retrospective study were 353 GC patients who underwent radical gastrectomy between 2009 and 2018. We examined the relationships between their clinical factors, including skeletal muscle mass index and intramuscular adipose tissue content (IMAC), and infectious complications after gastrectomy. RESULTS: Infectious complications developed in 59 patients (16.7%). The independent risk factors for infectious complications identified by multivariate analysis were male gender (P < 0.001), prognostic nutritional index below 45 (P = 0.006), and high IMAC (P = 0.011). Patients with a high IMAC were older and had a higher body mass index, as well as a greater age-adjusted Charlson comorbidity index, than those with low or normal IMAC. CONCLUSIONS: Low skeletal muscle quality defined by a high IMAC is a risk factor for infectious complications following gastrectomy. When feasible, preoperative nutritional intervention and rehabilitation aiming to improve muscle quality could reduce infectious complications after gastrectomy for GC.


Assuntos
Gastrectomia/efeitos adversos , Músculo Esquelético/patologia , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Avaliação Nutricional , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Neoplasias Gástricas/complicações , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Tomografia Computadorizada por Raios X
3.
J Pain Symptom Manage ; 60(6): 1163-1169, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32615299

RESUMO

CONTEXT: In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying. OBJECTIVES: To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death. METHODS: This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment. RESULTS: Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation. CONCLUSION: Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.


Assuntos
Luto , Hospitais para Doentes Terminais , Neoplasias , Assistência Terminal , Atitude Frente a Morte , Estudos Transversais , Morte , Família , Humanos , Pacientes Internados , Japão , Neoplasias/terapia , Cuidados Paliativos , Inquéritos e Questionários
4.
J Cardiol ; 76(2): 177-183, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199753

RESUMO

BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.


Assuntos
Doenças Cardiovasculares/terapia , Cuidados Paliativos/normas , Indicadores de Qualidade em Assistência à Saúde , Adulto , Consenso , Técnica Delfos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade
5.
J Pain Symptom Manage ; 60(1): 87-93, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32088356

RESUMO

CONTEXT: Dyspnea is one of the most distressing symptoms for terminally ill cancer patients and a predictor of poor prognosis. Identification of simple clinical signs, such as heart rate, indicating clinical course of each patient is of value. OBJECTIVES: To explore the potential association between heart rate and reversibility of the symptom, treatment response to palliative intervention, and survival in terminally ill cancer patients with dyspnea at rest. METHODS: This is a secondary analysis of a multicenter prospective cohort study of patients with advanced cancer to validate multiple prognostic tools. In the patients with dyspnea at rest at the baseline, we examined a potential association between heart rate and the reversibility of dyspnea and refractoriness to palliative treatment using logistic regression analysis. Survivals were compared using the Cox proportional hazards model among four groups with different levels of the heart rate (≤74, 75-84, 85-97, and ≥98). RESULTS: A total of 2298 patients were enrolled, and 418 patients (18%) had dyspnea at rest. Reversibility of dyspnea was significantly higher in the patients with lower heart rate (P for trend = 0.008), and the refractoriness to palliative treatment tended to be higher in the patients with higher heart rate (P for trend = 0.101). The median survival for each heart rate quartile groups was significantly higher in the lower heart rate group (24 vs. 21 vs. 14 vs. 9 days; heart rate ≤74, 75-84, 85-97, and ≥98, respectively; log-rank P < 0.001). CONCLUSION: Heart rate may help clinicians to make the prediction of the patient's clinical course more accurate.


Assuntos
Neoplasias , Cuidados Paliativos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/terapia , Frequência Cardíaca , Humanos , Neoplasias/complicações , Neoplasias/terapia , Prognóstico , Estudos Prospectivos
6.
J Anus Rectum Colon ; 3(2): 84-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559373

RESUMO

OBJECTIVES: Raman spectroscopy yields precise information, not only regarding the secondary structure of proteins but also regarding the discrimination between normal and malignant tissues. There is, however, no standard measurement method. We evaluated the use of a miniaturized, handheld, all-in-one Raman spectrometer with a 1064-nm laser excitation source for the diagnosis of colorectal cancer. The ultimate goal is real-time, in vivo diagnosis. METHODS: Tissue samples were obtained from 20 patients who underwent surgery for colorectal cancer. The samples were irradiated with the portable Progeny™ Raman spectrometer, with which the Raman spectra were also obtained. We searched for characteristic Raman shifts and examined whether these shifts could distinguish the cancer tissues. To improve accuracy, we divided the spectra into 100 cm-1 bands and applied principal component analysis (PCA) to each range. We evaluated the contribution of each range for cancer discrimination. RESULTS: Intensities at 1261 and 1427 cm-1 differed significantly between the normal tissues and cancer tissues, but these did not efficiently discriminate the cancer tissues. However, we were able to identify the characteristic spectral range in fingerprint regions; accuracy was 85.1%. CONCLUSIONS: Use of the all-in-one type Raman spectrometer can efficiently discriminate colorectal cancer, not on the basis of the intensities at 1261 and 1427 cm-1 but rather on the basis of PCA. Thus, Raman spectroscopy performed using a handheld device has potential to become a clinically powerful tool for producing high-quality data, obtaining highly reproducible measurements, and thus accurately diagnosing colorectal cancer.

7.
Indian J Palliat Care ; 25(1): 30-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30820098

RESUMO

Context: Although palliative care is rapidly being disseminated throughout Japan as a result of government policy, a systematic syllabus of palliative medicine for physicians has not been developed. Aims: This study aimed to develop a Japanese national consensus syllabus of palliative medicine for physicians. Design: We used a modified Delphi method to develop the consensus syllabus. Methods and Setting: We created a Delphi panel by selecting 20 expert eligible panelists consisting of Diplomate or Faculty of the Specialty Board of Palliative Medicine and certified by the Japanese Society for Palliative Medicine. We inducted external reviewers from 11 palliative care-related organizations. Results: Among 20 experts surveyed, 20 (100%) responded over all rounds. Ten (50%) participated in a panel meeting. In the first round, 179 of 179 (100%) learning objectives were judged to be appropriate and 5 of 179 (3%) learning objectives were judged to be too difficult. In the panel meeting, 25 learning objectives were excluded, three new learning objectives were added, and 15 learning objectives were reworded. In the second round, 18 of 18 (100%) learning objectives were judged to be appropriate. The final version of the syllabus developed consists of 157 specific behavioural objectives and 22 general instructional objectives across 22 courses. Conclusions: We have developed the first national consensus syllabus of palliative medicine for physicians in Japan. Based on this syllabus, a training program on palliative medicine will be established by training facilities in Japan, and physicians will be able to practice specific palliative care.

8.
Asian J Endosc Surg ; 12(3): 269-274, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30178535

RESUMO

INTRODUCTION: Generally, laparoscopic colorectal surgery is performed with the patient in the lithotomy and rotated positions. The lithotomy position, however, is associated with intraoperative peripheral nerve injury (IPNI). We studied the relationship between patient positioning during laparoscopic colorectal surgery, contact pressure at the shoulder, and the occurrence of IPNI and tested a positioning protocol aimed at surgical safety in addition to maintenance of a good surgical field. METHODS: We applied our positioning protocol in 44 cases and collected data that could be used to answer our study questions. We set limits for shoulder contact pressure and time in the rotation position. When the time limit was reached, we returned the patient to the supine position for 5 min. RESULTS: Patients' median age was 71 years; mean BMI was 22.4 kg/m2 . Median time in the rotation position was 126 min. For the 22 patients for whom validated data was obtained, mean lower shoulder pressure changed from 8.5 mmHg just after rotation to 11.4 mmHg 120 min after rotation (P = 0.013). Absence of IPNI in our patients confirmed the proposed relation between patient positioning and IPNI. Our data indicate that a prolonged period in the rotation position increases contact pressure at the shoulder, which can increase the risk of IPNI. CONCLUSION: Our patient positioning protocol appears to have prevented laparoscopic colectomy-related IPNI. Future studies are warranted to confirm the relationship between patient positioning and IPNI and, if necessary, to further refine the protocol to ensure prevention of IPNI during laparoscopic colorectal surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Laparoscopia/efeitos adversos , Posicionamento do Paciente , Traumatismos dos Nervos Periféricos/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Traumatismos dos Nervos Periféricos/etiologia , Pressão , Rotação , Ombro
9.
Eur J Cancer ; 105: 50-60, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30391780

RESUMO

INTRODUCTION: There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model. METHODS: A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method. RESULTS: Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation. CONCLUSION: We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research.


Assuntos
Testes Diagnósticos de Rotina , Modelos Estatísticos , Neoplasias/mortalidade , Prognóstico , Análise de Sobrevida , Sinais Vitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Humanos , Japão/epidemiologia , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Neoplasias/sangue , Neoplasias/patologia , Neoplasias/urina , Cuidados Paliativos , Exame Físico , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
10.
Cancer ; 123(8): 1442-1452, 2017 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27926777

RESUMO

BACKGROUND: Survival prediction systems such as the Palliative Prognostic Index (PPI), which includes the Palliative Performance Scale (PPS), are used to estimate survival for terminally ill patients. Oncologists are, however, less familiar with the PPS in comparison with the Eastern Cooperative Oncology Group (ECOG) performance status (PS). This study was designed to validate a simple survival prediction system for oncologists, the Performance Status-Based Palliative Prognostic Index (PS-PPI), which is a modified form of the PPI based on the ECOG PS. METHODS: This multicenter, prospective cohort study enrolled all consecutive patients who were referred to 58 palliative care services in Japan. The primary responsible physicians rated the variables required to calculate the PS-PPI and the PPI. Patient survival in these risk groups was compared, and the sensitivity and specificity of the PS-PPI and the PPI were evaluated. Patients were subclassified as patients receiving care from in-hospital palliative care teams, palliative care units, or home-based palliative care services. Subsets of patients receiving chemotherapy were also analyzed. RESULTS: This study included 2346 patients. Survival predictions based on the PPI and the PS-PPI differed significantly among the 3 risk groups (P < .001). The PS-PPI was more sensitive, whereas the PPI was more specific. All areas under the receiver operating characteristic curves of both indices were >0.78 for predicting survival at all times, from 3 weeks to 180 days. CONCLUSIONS: In predicting the prognosis of patients with advanced cancer, the PS-PPI was as accurate as the PPI. The PS-PPI was useful for short- and long-term survival prediction and for the prediction of survival for patients undergoing chemotherapy. Cancer 2017;123:1442-1452. © 2016 American Cancer Society.


Assuntos
Neoplasias/mortalidade , Análise de Sobrevida , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias/terapia , Oncologistas , Cuidados Paliativos , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
11.
J Pain Symptom Manage ; 51(5): 860-7, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26826676

RESUMO

CONTEXT: Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer. OBJECTIVES: To investigate CRP as a prognostic marker in palliative settings. METHODS: This multicenter prospective cohort study comprised 2426 patients. Laboratory data were obtained at baseline, and all patients were followed until death or six months after their enrollment. A total of 1511 patients were eligible for the analyses. They were divided into four groups: low-CRP (CRP < 1 mg/dL), moderate-CRP (1 ≤ CRP <5 mg/dL), high-CRP (5 ≤ CRP <10 mg/dL), and very high-CRP (10 mg/dL ≤ CRP) groups. Survival was investigated by the Kaplan-Meier method with the log-rank test. The 30-, 60-, and 90-day mortality rates were tested by Chi-squared tests. Univariate- and multivariate-adjusted hazard ratios (HRs) and 95% CIs in each group were calculated using Cox proportional hazard models. RESULTS: Survival rate decreased and mortality rate increased with increasing CRP level. The differences in survival and 30-, 60-, and 90-day mortality rates among the groups were statistically significant (P < 0.001). Baseline CRP level was significantly associated with a higher risk of mortality after adjustment for age, gender, primary tumor site, metastasis, chemotherapy, Eastern Cooperative Oncology Group Performance Status, and setting of care (moderate-CRP: HR 1.47 [95% CI 1.24-1.73], high-CRP: HR 2.09 [95% CI 1.74-2.50], and very high-CRP: HR 2.55 [95% CI 2.13-3.05] vs. low-CRP). CONCLUSION: Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.


Assuntos
Proteína C-Reativa/metabolismo , Neoplasias/sangue , Neoplasias/mortalidade , Cuidados Paliativos , Idoso , Biomarcadores/sangue , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Neoplasias/terapia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos
12.
Lancet Oncol ; 17(1): 115-22, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26610854

RESUMO

BACKGROUND: Continuous deep sedation (CDS) before death is a form of palliative sedation therapy that has become a focus of strong debate, especially with respect to whether it shortens survival. We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival. METHODS: This study was a secondary analysis of a large multicentre prospective cohort study that recruited and followed up patients between Sept 3, 2012, and April 30, 2014, from 58 palliative care institutions across Japan, including hospital palliative care settings, inpatient palliative care units, and home-based palliative care services. Adult patients (aged ≥ 20 years) with advanced cancer who received care through the participating palliative care services were eligible for this secondary analysis. Patients with missing data for outcome variables or who lived for more than 180 days were excluded. We compared survival after enrolment between patients who did and did not receive CDS. We used a propensity score-weighting method to control for patient characteristics, disease status, and symptom burden at enrolment. FINDINGS: Of 2426 enrolled patients with advanced cancer, we excluded 289 (12%) for living longer than 180 days and 310 (13%) with missing data, leaving an analysis population of 1827 patients. 269 (15%) of 1827 patients received CDS. Unweighted median survival was 27 days (95% CI 22-30) in the CDS group and 26 days (24-27) in the no CDS group (median difference -1 day [95% CI -5 to 4]; HR 0·92 [95% CI 0·81-1·05]; log-rank p=0·20). After propensity-score weighting, these values were 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1·01 [95% CI 0·87-1·17]; log-rank p=0·91). Age (p(interaction)=0·67), sex (p(interaction)=0·26), performance status (p(interaction)=0·90), and volume of artificial hydration (p(interaction)=0·14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (p(interaction)=0·021). INTERPRETATION: CDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialised palliative care services, and could be considered a viable option for palliative care in this setting. FUNDING: Japanese National Cancer Center Research and Development Fund.


Assuntos
Sedação Profunda , Neoplasias/mortalidade , Neoplasias/terapia , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hidratação , Serviços de Assistência Domiciliar , Hospitais para Doentes Terminais , Hospitais , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Prospectivos , Taxa de Sobrevida
13.
Oncologist ; 20(7): 839-44, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26054631

RESUMO

BACKGROUND: Predicting the short-term survival in cancer patients is an important issue for patients, family, and oncologists. Although the prognostic accuracy of the surprise question has value in 1-year mortality for cancer patients, the prognostic value for short-term survival has not been formally assessed. The primary aim of the present study was to assess the prognostic value of the surprise question for 7-day and 30-day survival in patients with advanced cancer. PATIENTS AND METHODS: The present multicenter prospective cohort study was conducted in Japan from September 2012 through April 2014, involving 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services. RESULTS: We recruited 2,425 patients and included 2,361 for analysis: 912 from hospital-based palliative care teams, 895 from hospital palliative care units, and 554 from home-based palliative care services. The sensitivity, specificity, positive predictive value, and negative predictive value of the 7-day survival surprise question were 84.7% (95% confidence interval [CI], 80.7%-88.0%), 68.0% (95% CI, 67.3%-68.5%), 30.3% (95% CI, 28.9%-31.5%), and 96.4% (95% CI, 95.5%-97.2%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for the 30-day surprise question were 95.6% (95% CI, 94.4%-96.6%), 37.0% (95% CI, 35.9%-37.9%), 57.6% (95% CI, 56.8%-58.2%), and 90.4% (95% CI, 87.7%-92.6%), respectively. CONCLUSION: Surprise questions are useful for screening patients for short survival. However, the high false-positive rates do not allow clinicians to provide definitive prognosis prediction. IMPLICATIONS FOR PRACTICE: The findings of this study indicate that clinicians can screen patients for 7- or 30-day survival using surprise questions with 90% or more sensitivity. Clinicians cannot provide accurate prognosis estimation, and all patients will not always die within the defined periods. The screened patients can be regarded as the subjects to be prepared for approaching death, and proactive discussion would be useful for such patients.


Assuntos
Neoplasias/mortalidade , Cuidados Paliativos/psicologia , Idoso , Estudos de Coortes , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Médicos , Prognóstico , Análise de Sobrevida
14.
Eur J Cancer ; 51(12): 1618-29, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26074396

RESUMO

PURPOSE: The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model). PATIENTS AND METHODS: This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy. RESULTS: We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores. CONCLUSION: The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.


Assuntos
Delírio/mortalidade , Nível de Saúde , Neoplasias/mortalidade , Cuidados Paliativos , Adulto , Idoso , Idoso de 80 Anos ou mais , Delírio/complicações , Estudos de Viabilidade , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/patologia , Cuidados Paliativos/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Análise de Sobrevida
15.
Am J Hosp Palliat Care ; 32(7): 695-702, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24907122

RESUMO

The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status.


Assuntos
Atividades Cotidianas , Neoplasias/reabilitação , Qualidade de Vida , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Tempo de Internação , Masculino , Metástase Neoplásica , Neoplasias/fisiopatologia , Percepção , Recuperação de Função Fisiológica , Centros de Reabilitação
16.
J Pain Symptom Manage ; 47(3): 579-587.e6, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23972575

RESUMO

CONTEXT: The many benefits of hospital palliative care teams (PCTs) are well known. However, their specific activities have not been fully clarified, and no standardized methods for reporting PCT activities are available. OBJECTIVES: The aim of this study was to investigate, through the use of a standard format, the activities performed by hospital PCTs in Japan. METHODS: This was a prospective observational study. A total of 21 hospital PCTs were included in this study, and each recruited approximately 50 consecutively referred patients. Participating PCTs filled in a standard form for reporting activities. RESULTS: We obtained data from 1055 patients who were referred to PCTs. Of the 1055 patients, 1005 patients (95%) had cancer. The median number of reasons for referral and problems identified by PCTs was two (0-22) and four (0-18), respectively. The two major reasons for referral were pain (63%) and anxiety/depression/grief/emotional burden (22%). The major recommendations were pharmacological treatment (74%), care for the patient's physical symptoms (49%), and support for patient's decision making (38%). The major activities performed by the PCTs were comprehensive assessment (90%), care for the patient's physical symptoms (77%), and pharmacological treatment (74%). CONCLUSION: The components of hospital PCT activities were successfully measured using the Standard Format for Reporting Hospital PCT Activity. The results of this study and the format for reporting hospital PCT activity could be effective in improving hospital PCT practice and for the education of new hospital PCT members.


Assuntos
Registros Hospitalares , Hospitais/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Tomada de Decisões , Feminino , Humanos , Japão , Masculino , Transtornos Mentais/terapia , Neoplasias/terapia , Manejo da Dor/estatística & dados numéricos , Cuidados Paliativos/métodos , Estudos Prospectivos
17.
J Opioid Manag ; 5(2): 107-14, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19507807

RESUMO

BACKGROUND: Limited case reports have suggested a role for methadone as an analgesic for chronic pain in patients maintained on methadone for treatment of opiate addiction. Patients with HIV are disproportionately represented in this population and often have severe, debilitating chronic pain syndromes of multiple etiologies, including cancer-related pain syndromes. OBJECTIVE: This study evaluated the safety and efficacy of initiating and maintaining additional methadone for chronic pain in HIV-positive patients with ongoing treatment for opiate addiction in methadone maintenance treatment programs (MMTPs). METHODS: We performed a retrospective chart review of 53 HIV/AIDS patients (36 male, 1 7 female; 24 with cancer) with diverse chronic pain syndromes who were followed in an HIV Pain Clinic and were currently enrolled in an MMTP. The outcome measure was pain, assessed using a numeric rating scale (0-10). Incidence of heroin use was also measured. RESULTS: The mean methadone dose initially prescribed for analgesia was approximately equal to 67 percent of the methadone dose used in the MMTP for addiction. Over the 12-month retrospective observation period, methadone was titrated to approximately 200 percent of the methadone maintenance dose. The mean pain score at initial visit to the Pain Clinic was 9.4 +/- 1.03. After methadone for analgesia has been administered for 1 month, the mean pain score decreased to 5.35 +/- 1.7 (p < 0.001), at 3 months, 4.8 +/- 1.3 (p < 0.001), at 6 months, 4.2 +/- 1.7 (p < 0.001), and at 12 months, 4.2 +/- 1.4 (p< 0.001). No serious adverse events or side effects were observed with methadone therapy for analgesia. CONCLUSION: HIV/AIDS patients with chronic pain enrolled in MMTPs achieved improved analgesia with no serious side effects when additional methadone was administered for pain relief. Further controlled studies are needed to confirm our findings and to establish the safety and efficacy of methadone therapy for chronic pain in this population.


Assuntos
Analgésicos Opioides/uso terapêutico , Infecções por HIV/complicações , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Dor/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Metadona/administração & dosagem , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/complicações , Dor/complicações , Medição da Dor , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
J Pain Symptom Manage ; 34(5): 566-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17616330

RESUMO

Recent case reports have raised concerns about the potential for methadone to prolong the QTc interval (QT corrected for heart rate) and predispose patients to torsade de pointes (TdP), a life-threatening arrhythmia. We present a case report that describes the successful use of parenteral and oral methadone in a patient with uncontrolled cancer pain and a history of QTc prolongation. We describe an approach to the use of methadone in this patient and review both case reports and recent prospective studies that have evaluated the risk of TdP and the long-term outcome with respect to the development of TdP in patients receiving methadone for chronic pain or addiction.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Síndrome do QT Longo/complicações , Metadona/administração & dosagem , Metadona/uso terapêutico , Dor Intratável/tratamento farmacológico , Carcinoma de Células Renais/complicações , Humanos , Infusões Parenterais , Neoplasias Renais/complicações , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor Intratável/etiologia , Cuidados Paliativos
19.
J Pain Symptom Manage ; 29(4): 385-91, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15857742

RESUMO

Recent reports suggest that methadone may prolong the QTc interval and cause torsades de pointes. This study was conducted to evaluate the prevalence of QTc prolongation during oral methadone therapy and identify factors associated with prolongation. Patients receiving oral methadone as treatment for chronic pain or addiction were eligible for the study. One hundred four patients who were receiving > or = 20 mg methadone per day for > or = 2 weeks underwent electrocardiograms to measure QTc interval duration. Sixty-three (61%) patients were male and 63 (61%) were receiving methadone maintenance for opioid addiction. The mean (+/- SD) age was 45.3 +/- 9.4 years. The median (range) methadone dose was 110 mg/day (20-1200 mg/day); median (range) number of months on methadone was 12.5 months (1-444 months). The median (range) QTc interval was 428 msec (396-494 msec). Thirty-three percent had QTc prolongation (males 40%, females 20%; P=0.03). No patient had a QTc longer than 500 msec. Significant dose response was observed in males on methadone <12 months (rho=0.60, P=0.02). Our study suggests that methadone may prolong the QTc interval in specific subpopulations but poses little risk of serious prolongation.


Assuntos
Frequência Cardíaca/efeitos dos fármacos , Metadona/efeitos adversos , Metadona/uso terapêutico , Medição de Risco/métodos , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/diagnóstico , Eletrocardiografia , Feminino , Dependência de Heroína/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Fatores de Risco
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