The Prognostic Nutrition Index Predicts the Development of Hematological Toxicities in and the Prognosis of Esophageal Cancer Patients Treated with Cisplatin Plus 5-Fluorouracil Chemotherapy.

The prognostic nutrition index (PNI), calculated based on serum albumin and lymphocyte counts, predicts the prognosis of several cancers, including operated esophageal cancers. In this study, we determined whether PNI could predict the occurrence of severe adverse events by chemotherapy and chemoradiotherapy, and overall survival in esophageal cancer. We collected data from 191 patients with esophageal cancer treated with at least one course of cisplatin and 5-fluorouracil from 2005 to 2016. We compared the incidences of severe adverse events and overall survival between a high- and a low-PNI group. The optimal cut-off value of the Onodera PNI was 43.2. Patients with low PNIs suffered more frequent severe adverse events than did those with high PNIs, and the latter patients survived longer. The PNI was independently prognostic of overall survival and stage. The PNI predicted the development of severe adverse events caused by chemotherapy or chemoradiotherapy, and overall survival, in esophageal cancer patients.

Changes in Psychological Condition during Cancer Chemotherapy.

BACKGROUND: Psychological disorders are prevalent in cancer patients and their psychological condition can change during cancer chemotherapy and influence their quality of life and adherence to treatment. PATIENTS AND METHODS: This prospective observational study enrolled cancer patients undergoing chemotherapy. The enrolled patients were assessed at the start of chemotherapy, after the first course of chemotherapy, and more than 2 months later by themselves and by medical staff using four different items. The cancer patients assessed themselves using the Numerical Rating Scale for Anxiety (NRS-A), Hospital Anxiety and Depression Scale subscale for anxiety (HADS-A) and subscale for depression (HADS-D), and patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). A pharmacist or nurse assessed them using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS: This study enrolled 109 patients. The anxiety and depression scores were highest at the start of chemotherapy and declined thereafter. Patients with history of psychiatric disorders or taking psychotropic drugs had higher scores than those without such disorders or treatments (P < 0.05), and tended to maintain these high scores at the second and third HADS-A and -D assessments. The scores assessed by the patients themselves were higher than those assessed by the medical staff. CONCLUSION: Psychiatric distress scores were highest when commencing chemotherapy and declined thereafter. The patients with history of psychiatric disorders or taking psychotropic drugs kept higher scores of HADS-A and -D during whole chemotherapy courses.

Cancers among adolescents and young adults at one institution in Japan.

Adolescents and young adults (AYAs) with cancer often live long lives following treatment and face many life events. No detailed studies of cancers in AYAs have described the epidemiology, treatment outcome, and social status in Japan. The present study defined AYAs as those aged 15-29 years old based on the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. Data was collected from the hospital-based cancer registry and electronic medical charts at Niigata University Medical and Dental Hospital from 2007 to 2015. The present study analyzed the types of cancer, treatment methods and outcomes, fertility preservation, marital status, raising children, school admission, and employment status. A total of 362 (1.9%) cancer cases in AYAs (males 119, females 243) were identified. Carcinoma was the most common type of cancer in both sexes. Females had a high incidence of carcinoma of the genitourinary tract (28.0%). Fertility-sparing surgery (16.0%) was the most common method of fertility preservation. The 5-year survival was better in females (88.4%) than in males (79.9%). The percentage of married AYAs increased following cancer treatment. The proportion of unemployment increased following cancer treatment in all age groups and was greatest (12.6%) in those aged 20-24 years old. Compared with SEER data from the United States, the incidence of carcinoma was high among AYAs, particularly genitourinary tract carcinomas in females, while the incidence of melanoma and skin carcinomas was low. Therefore, AYAs with cancer requires social and economic support.

Myelosuppression by chemotherapy in obese patients with gynecological cancers.

PURPOSE: The American Society of Clinical Oncology provides clinical practice guidelines for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. The panel recommends that actual body weight should be used when selecting cytotoxic chemotherapy doses regardless of obesity status. However, there have been no reports regarding the appropriate cytotoxic chemotherapy dosing for obese Japanese patients with cancer. PATIENTS AND METHODS: We collected data from 216 gynecological cancer patients who were treated with at least one course of a paclitaxel and carboplatin (TC) regimen or a docetaxel and carboplatin (DC) regimen at Niigata University Medical and Dental Hospital from July 2006 to April 2014. Patients were divided into three groups according to body mass index (BMI): obese (BMI ≥ 25), normal (BMI 18.5-24.9), and underweight (BMI < 18.5), as defined by the Japan Society for the Study of Obesity. We analyzed hematological toxicities by full weight-based chemotherapy in each group. RESULTS: The rates of grade 3/4 leukocytopenia, neutropenia, and thrombocytopenia were not significantly different among the three BMI groups on all patient analyses. For the TC regimen, the obese and normal groups had significantly lower leukocytopenia (grade 3/4) rates than did the underweight group. Also, significant positive correlations between BMI and the nadirs of leukocytes, neutrophils, platelets, and hemoglobin were observed. For the DC regimen, no significant difference was observed among the BMI groups and the rate of grade 3/4 hematological toxicities. CONCLUSIONS: We did not observe stronger myelosuppression in obese cancer patients compared with non-obese cancer patients. Therefore, the cytotoxic chemotherapy dose should be calculated by the actual body weight and unnecessary dose reduction should be avoided.