Nobuhisa Nakajima

• MD,PhD
• Professor (Associate) at Tohoku University

Purpose Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition. Meth...

Background: Swallowing disorders including difficulty swallowing and food bolus obstruction, result in reduced dietary intake-a common occurrence that leads to cachexia in patients with advanced cancer. This study examined the effects of swallowing difficulty and food bolus obstruction on cachexia-related quality of life (QOL). Methods: This stu...

PurposeTaste and smell are used to enjoy meals; however, impairments of these sensory perceptions seriously impact health and eating habits. This study is aimed at investigating the impact of taste and smell disturbances on dietary intakes and cachexia-related quality of life (QOL) in patients with advanced cancer.Methods Using a self-report questi...

Background: Eating-related distress (ERD) is one type of psychosocial distress among advanced cancer patients and family caregivers. Its alleviation is a key issue in palliative care; however, there is no validated tool for measuring ERD. Methods: The purpose of this study was to validate tools for evaluating ERD among patients and family caregi...

Background This study aimed to investigate the effectiveness of anticholinergics (AC) for death rattle in dying patients with cancer. Methods This is a prospective cohort study enrolled Terminally ill adult (20 years or older) patients with cancer who developed substantial death rattle (Back score ≥2) from 23 palliative care units in Japan. AC tre...

(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of “patient evaluation” (PRO) and “peer evaluation” by medical professionals, was de...

Purpose All five senses (i.e., sight, smell, hearing, taste, and touch) are used to enjoy meals; however, impairments in sensory perception, which are common among cancer patients, seriously impact health and cause eating-related distress. Methods Using a self-report questionnaire, we surveyed patients with advanced cancer undergoing treatment at...

Background: The beliefs and perceptions of parenteral nutrition and hydration (PNH) by advanced cancer patients have not been elucidated. Objectives: To clarify their beliefs and perceptions and to explore the relationships between their beliefs and perceptions and cachexia stages. Design/setting/subjects: A questionnaire survey of advanced cancer...

Background The relationships between cachexia stages and the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS) 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns have not been investigated in Asian patients with advanced cancer. Methods This is a multicentre questionnaire survey conducted in pal...

Purpose: Artificial hydration and nutrition therapy (AHNT) initiated by patients/families sometimes differs from medically appropriate treatment plans. We aimed to identify the causes of these differences and examine the ensuing responses and outcomes. Methods: Of 133 adult cancer patients receiving end-of-life care in the last 2 years, these di...

Purpose Objectives of this study are to clarify the beliefs and perceptions of parenteral nutrition and hydration (PNH) by patients with advanced cancer and to examine the relationships between their beliefs and perceptions and cachexia stages. Methods We conducted a questionnaire survey. We asked about patient characteristics and anthropometric me...

Objective There is no widely used prognostic model for delirium in patients with advanced cancer. The present study aimed to develop a decision tree prediction model for a short-term outcome. Method This is a secondary analysis of a multicenter and prospective observational study conducted at 9 psycho-oncology consultation services and 14 inpatien...

Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study...

Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physicia...

Purpose: Palliative care is constructed by various kinds of professionals. This study aimed to identify the challenges that dental hygienists (DHs) encountered when working with other professionals in a multidisciplinary team approach in palliative care for advanced cancer patients. Methods: We conducted the following two studies: (1) a question...

When we aim to construct palliative care and community development for a dignified and secure society, it is important to work from the viewpoint of communication. Communication in palliative care is usually divided into three categories as follows: between patients and families, between medical professionals, between patients/families and medical...

Background Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for patients with terminal cancer. The Japanese Society for Palliative Medicine published the guideline for AHT in 2007, and it was revised in 2013 based on the concept of cancer cachexia. Objectives The purpose of this study was to evaluate the...

Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary...

Background Over the past decade, multiple randomized controlled trials have demonstrated that involvement of palliative care services concurrent with chemotherapy (Cx) can improve health outcomes including overall survival. It is widely accepted that not only inpatients, but also outpatients with advanced cancer should receive dedicated palliative...

Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Curren...

Objectives: Although transthyretin (TTR) is a nutritional indicator and is influenced by systemic inflammation, it may be a good prognostic indicator for cancer patients in palliative care settings. This study investigates the correlation between low TTR levels and survival among cancer patients in palliative care settings. Methods: This was a sub-...

Background: Urological symptoms such as gross hematuria, lower and upper urinary tract symptoms, and bladder pain are common in and distressing for patients with advanced cancer. Although palliation of urological symptoms is important to improve the quality of life of cancer patients and their families and caregivers, clinical guidelines for manag...

Aim: To clarify the predictive risk factors for bedsores of terminal cancer patients receiving home-based care. Methods: A retrospective study was conducted involving 95 terminal cancer patients receiving home-based care, including people using services provided by home-visit care providers until death. Results: The numbers of patients with and wit...

Background: The association between C-reactive protein (CRP) level, symptoms, and activities of daily living (ADL) in advanced cancer patients is unclear. Methods: Secondary data analysis of a multicenter prospective cohort study consisted of 2426 advanced cancer patients referred to palliative care settings was conducted to examine the cross-se...

Background Japan's first guidelines for parenteral fluid management for terminal cancer patients were issued in 2006. These guidelines focused on the fluid levels to administer to patients with a remaining life expectancy of 1–2 months. However, recent refinement of the concept of cachexia is prompting caregivers worldwide to rethink parenteral flu...

Background: Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital. Methods: This...

Purpose: Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. Methods: The study subjects were consecut...

The Glasgow prognostic score (GPS), which uses C-reactive protein and albumin levels, is a good predictor of prognosis in cancer patients undergoing anti-tumor therapy. The objective of this study was to investigate the correlation between GPS and survival among cancer patients in palliative settings, as findings in such populations have not been w...

Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams. The primary aim of this study is to examine the accuracy and to validate...

To evaluate the effectiveness of specialized palliative care (PC) administered at the time of administration of first-line chemotherapy for cancer progression. Patients who received regular specialist PC concomitantly with first-line chemotherapy after being diagnosed with progressive disease assigned to PC group. Patients transferred to palliative...

Purpose of review: To update medical professionals on the role of artificial hydration in terminally ill cancer patients and to highlight recent research. Recent findings: First, we explain dehydration-related symptoms such as sensation of thirst, fatigue, and delirium. A multicenter, double-blinded, placebo-controlled randomized trial showed th...

Purpose: Effective and faithful communication between patients and medical professionals could improve patients' quality of life and is an essential and fundamental factor in cancer treatment. The purpose of this study was to examine whether disclosing more detailed information about disease progression toterminally ill patients could improve the...

Background: Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for terminally ill cancer patients. Some studies have demonstrated that appropriate hydration can contribute to patient comfort; however, few studies have examined the effects of volume reduction on patient symptoms and quality of life (QOL)....

More than 30 years have passed since the introduction of the concept of palliative care in cancer care in Japan. However, the majority of the estimated three million cancer patients in Japan do not receive palliative care. Higashi Sapporo Hospital was established in 1983 as a hospital specialized in cancer care. The palliative care unit of our hosp...

Background: Current discrepancies in the practice of artificial hydration therapy for terminally ill cancer patients have the potential to cause serious clinical problems. Purpose: The study's purpose was to explore the influence of hydration volume on the sings during the last three weeks of life in terminally ill cancer patients. Methods: Th...

Aims: To examine the relationship between informing patients of cancer and the quality of terminal care. Methods: This was a study of 87 consecutive terminally ill cancer patients who died during the last 27-month period. Notification of cancer was classified into 4 groups (A, B, C, and D, respectively): "nondisclosure," "disclosure of cancer di...

Although an evidence-based clinical guideline for parenteral hydration therapy was established in Japan, the efficacy of the guideline has not been assessed. Our purpose was to explore the effect of parenteral hydration therapy based on this clinical guideline on quality of life (QoL), discomfort, symptoms, and fluid retention signs in patients wit...

The aim of this study was to evaluate the efficacy and safety of octreotide for malignant bowel obstruction in a multicenter study. Terminally ill patients diagnosed with inoperable malignant bowel obstruction were treated with octreotide 300 microg/day. The primary endpoint was the overall improvement rate of subjective abdominal symptoms. The deg...

In northwestern part of Honshu, Tertiary granitoids with 13.9 to 6.0 Ma age data, that is thought to be in a period of vein type mineralization, show the intermittent distributions in NE-SW and NW-SE trend. It suggests that the granitoids intruded along shear zones formed by common maximum compressive stress in E-W trend. Veins are hosted in E-W, N...

Loxoprofen sodium is one of the non-steroidal anti-inflammatory drugs (NSAIDs) that is a prodrug. Several adverse effects of the drug have been described, but ileal ulcer has not been reported so far. We experienced an 87-year-old male patient with disk herniation complicated with loxoprofen sodium-induced multiple ileal ulcers and an ileal Dieulaf...

鼠径ヘルニアは一般外科手術の中で占める割合の高い疾患であるが,鼠径ヘルニア嚢に悪性腫瘍が存在する頻度は少ない.今回,われわれはS状結腸癌が右鼠径ヘルニア嚢に転移をきたした症例を経験した.症例は55歳,女性. S状結腸癌術後CEA高値が遷延し腹部造影CTにて右鼠径部に増強効果のある約2.5cmの腫瘤を認めた.吸引細胞診にてS状結腸癌と同様の腺癌を認め, S状結腸癌の右鼠径ヘルニア嚢転移と診断された.その後の全身精査にて他に転移を認めず,単発性鼠径ヘルニア嚢転移と考えられ摘出術を施行した.浸潤の疑われた横筋筋膜,外腹斜筋腱膜の一部も含め合併切除し,組織欠損に対しては, PROLENE Hernia System® (Johnson & Johnson)を使用しTension freeにてヘルニア...

A 56-year-old man who underwent distal gastrectomy at another hospital was admitted to our hospital because of advanced gastric cancer with synchronous liver metastasis. As we considered that the metastatic liver tumor was unresectable one, an intra-arterial catheter was inserted and weekly chemotherapy including methotrexate (MTX) (intra-venous) a...

最近7年間に当科で手術を行ったgastrointestinal stromal tumor (以下, GIST)11症例について臨床病理学的および免疫組織学的検討を行った.発生部位は胃8例,十二指腸1例,小腸2例で,免疫組織学的検査の結果, c-kit, CD34, SMA, S-100の陽性率はそれぞれ100%, 81%, 27%, 0%であり,これよりuncommitted typeが8例, smooth muscle typeが3例と分類された.良悪性の診断は,病理組織学的に低悪性度が2例,悪性が4例であり,このうちの3例で転移再発を認めた. p53, Ki-67は悪性度診断,転移再発を予測する上で有用であった.本疾患の概念は未だ流動的だが,今後,個々の腫瘍の生物学的特性をさらに明らか...

The number of Dieulafoy-erosion gastric ulcers reported has recently increased, although this ulcer of the small intestine is very rare. We treated a patient of bleeding from a Dieulafoy-erosion ileal ulcer. A 87-year-old man was admitted to our hospital with melena. Scintigraphy (99mTc-RBC) showed an accumulation in the right lower quadrant. Emerg...

True carcinosarcoma is extremely rare and is characterized by a mixed tumor composed of a carcinoma and a genuine sarcoma. We described here a case of true carcinosarcoma of the esophagus complicated with early gastric cancer. A 63-year-old man was admitted to our hospital with complaints of dysphagia. Endoscopic examination showed a type 1+2+IIc l...

比較的まれと思われる肺癌からの転移性空腸腫瘍による腸重積症の1例を経験したので報告する.症例は69歳の男性で, イレウス症状を呈して入院.小腸造影, 腹部CT検査より空腸腸重積症を疑い緊急開腹術を施行した.Treitz靱帯より約40cm肛門側に腫瘍を先進部とした空腸腸重積症をみとめ, 空腸部分切除術を施行した.空腸腸間膜リンパ節, および肝臓に多発性の転移性腫瘍をみとめたが, 他の腹腔内臓器には異常をみとめなかった.腫瘍は粘膜下層を中心として発育しており, 病理組織学的には, 転移性腫瘍の特徴を有した未分化癌であった.胸部単純写真, 胸部CTにて右S6の直径2cmの腫瘍と, 右肺門部異常陰影をみとめ, 喀痰細胞診より肺癌と診断し, 臨床的に肺が原発巣と考えられた.

A 55-year-old man was admitted with abdominal pain and nausea. CT-scan and US showed no abnormal findings. On the 5th hospital day, a large mass was palpable on the upper abdomen, and CT-scan (7th hospital day) demonstrated a large, cystic mass below the left lobe. A thoracentesis under ultrasound guidance obtained bile-stained fluid. PTCD revealed...

Lymphangioma can occur in every part of the body, but rarely found in the gastrointestinal organs, especially the large intestine. In this paper recent experience with lymphangioma of the descending colon is described with a review of 82 cases seen in the Japanese literature.A 26-year-old man visited the hospital because of abdominal pain and melen...

A rare case of solid and cystic tumor of the pancreas is described with a review of 121 collective cases reported in Japan.A 22-year-old woman consulted our hospital because of continuous upper abdominal pain. A fist-sized tumor was palpated in the right upper abdomen. CT scan showed a cystic tumor located in the head of the pancreas, with the size...

肝原発の悪性線維性組織球腫(以下,MFH)の1例を経験した.症例は54歳,男性で,主訴は体重減少であった.入院時検査では特記すべき所見はなく,HBs-Agは陰性,AFP等の腫瘍マーカーも正常域であった.腫瘍はS7にあり,大きさは8×7cmで,CTscanでは比較的境界明瞭なlow density areaとして描出され,腹部血管造影ではhypovascularであった.腫瘍は一部横隔膜に浸潤していたため,右後区域切除,S5及び横隔膜部分切除と右肝動脈カニュレーションを施行した.病理組織学的には,線維芽細胞様細胞と組織球様細胞とからなり,stori form patternが著明に認められ,MFHと診断された.術後の化学療法は効を奏さず,腹膜播腫,肺転移を生じ,術後60日目に死亡した.肝原発の...