Kyoji Ogoshi

Tokai University, Hiratuka, Kanagawa, Japan

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Publications (158)185.1 Total impact

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    ABSTRACT: We report a case of early esophageal carcinomas associated with achalasia treated by endoscopic submucosal dissection. A 46-year-old man was diagnosed of esophageal achalasia, flask type and Grade II in 2001, and had been treated by pneumatic dilatation for symptomatic achalasia conservatively. The patient was operated by Tokai University method, Heller's long esophagomyectomy, Hill's posterior cardiopexy, fundoplication and selective proximal vagotomy using a laparotomy in August 2009. One year and three months after the operation, two lesions of early carcinomas of type 0-IIb and 0-IIc, each 1cm in size, were detected in the middle thoracic esophagus, and treated by endoscopic submucosal dissection. Pathological examination of the each lesion revealed proliferation of squamous cell carcinoma in situ (T1a-EP). The entire esophageal mucosa around the carcinoma demonstrated hyperplastic changes of stratified squamous epithelium and foci of intraepithelial neoplasia. In the patient of achalasia, food stasis in esophagus is thought to induce chronic hyperplastic esophagitis, converting eventually to malignant transformation. Achalasia is known as a risk factor of esophageal squamous cell carcinoma. Careful long-term follow-up for patients of achalasia by endoscopic screening is recommended, even if after treatment by pneumatic dilatation or operation for achalasia.
    No preview · Article · Jan 2014 · Annals of Cancer Research and Therapy
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    ABSTRACT: Prominent lymphocytic infiltration and lymphoid follicles surrounding tumor cells are extremely rare findings in esophageal carcinoma. We report on the endoscopic, histological, and immunohistochemical features of a rare case of squamous cell carcinoma of the esophagus with lymphoid stroma. A 59-year-old woman was diagnosed with type 0-Is superficial esophageal carcinoma and underwent radical esophagectomy with lymph node dissection. Macroscopically, the tumor was protruding, and was covered with normal epithelium resembling a submucosal tumor. Histopathological examination demonstrated that the esophageal lesion was classified as a poorly differentiated squamous cell carcinoma with lymphoid stroma, extending to the deep submucosa (SM3) with lymph node metastasis (T1b, N2, M0, stage II). Epstein-Barr virus infection was ruled out by immunohistochemical and in situ hybridization analyses. Infiltrating B-lymphocytes were observed forming lymphoid follicles adjacent to carcinoma cell nests, and numerous T lymphocytes were widely spread throughout the specimen, as well as distributed in the marginal zone of the lymphoid follicles. Prominent human leukocyte antigen DR region (HLA-DR) immunoreactivity was noted in most carcinoma cells and focally infiltrating B cells in the lymphoid follicles, and these observations were thought to be due to activation of immunological interactions between carcinoma cells positive for HLA-DR and host lymphocytes.
    No preview · Article · Jan 2014 · Annals of Cancer Research and Therapy
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    ABSTRACT: Background: The question in the title remains unanswered and also is both old and new among gastric surgeons. Although there have been many reports about the early-stage quality of life and postoperative morbidity, they have failed to conclude about the advantages of these two reconstructions after distal gastrectomy. In this study, we summarized more than 30 years of experience and evaluated whether the Billroth I or Billroth II reconstruction procedure is better for patient survival after distal gastrectomy. Methods: From January 1977 to August 2005, a total of 1410 gastric cancer patients underwent distal gastrectomy with Billroth I (n=1184) or Billroth II (n=226) reconstruction in the Department of Gastroenterological Surgery, Tokai University. The 10- and 20-year follow-up cases numbered 980 (82.8%) and 692 (58.4%) for Billroth I, and 213 (94.2%) and 195 (86.3%) for Billroth II as of September 2009, respectively. Among them, 1015 patients (72.0%) received curative resection and were followed to evaluate the types of recurrence. Results: In the patients with Billroth I and Billroth II, the 5-, 10-, 15-, and 20-year survival rates were 77.4%, 66.6%, 56.0%, and 45.7%, and 39.7%, 32.8%, 25.9%, and 19.6%, respectively (P<0.0001; relative risk, 2.683; 95% confidence interval, 2.261-3.183). The patients in stages 1A and 4 showed significantly better survival with Billroth I than with Billroth II. The patients with Billroth II (10/86, 11.6%) showed significantly higher hematogenous recurrence than those with Billroth I (41/929, 4.4%). Conclusions: If gastric cancer patients must receive distal gastrectomy, we recommend they receive Billroth I reconstruction.
    No preview · Article · Jan 2013 · Annals of Cancer Research and Therapy
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    Kazuhito Nabeshima · Kyoji Ogoshi
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    ABSTRACT: The aim of this study was to clarify the influence of histological changes in the gastric remnant on Helicobacter pylori (H. pylori) infection after distal gastrectomy (DG) and proximal gastrectomy (PG). In total, 101 patients who underwent DG (n = 76) or PG (n = 25) for gastric cancer were included in the study. Three biopsy specimens from the remnant stomach were obtained during upper gastrointestinal endoscopy. Each specimen was scored according to the updated Sydney system for classifying gastritis and was examined for H. pylori infection. The H. pylori infection rate after DG was 60.5% while that after PG was 20.0% (P < 0.001). The histological score for neutrophils after DG was 60.5% while that after PG was 12.9% (P < 0.001). Intestinal metaplasia after PG was 76.0% while that after DG was 22.4% (P < 0.001). No differences in mononuclear cells or atrophy were observed between the two gastrectomy groups. H. pylori infection occurred more frequently after DG than after PG. Histological inflammation of the gastric remnant after DG was higher than that after PG. Intestinal metaplasia of the gastric remnant after PG was higher than that after DG. The intestinal metaplasia that induced inflammation indicated that H. pylori infection after PG was at a low level.
    Preview · Article · Dec 2011 · The Tokai journal of experimental and clinical medicine
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    ABSTRACT: An annular pancreas is an uncommon congenital anomaly that usually presents early in childhood. Malignancy in the setting of an annular pancreas is unusual. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 59-year-old man presented with epigastric discomfort and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla of Vater. Preoperative imaging showed the pancreatic parenchyma encircling the descending duodenum and a tumor at the papilla of Vater. A pancreaticoduodenectomy was performed for the annular pancreas and the ampullary tumor. Histological examination confirmed a complete annular pancreas and carcinoma in situ of the papilla of Vater. We also provide a review of the reported cases of an annular pancreas with periampullary neoplasms and discuss the clinical characteristics of this anomaly.
    No preview · Article · Nov 2011 · Surgery Today
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    ABSTRACT: BACKGROUND: Imatinib mesylate, a small-molecule tyrosine kinase inhibitor, is currently used for adjuvant therapy of patients who have undergone resection of high-risk gastrointestinal stromal tumors (GISTs). There are no data concerning the efficacy and safety of postoperative adjuvant therapy with imatinib for Japanese or East Asian patients with GIST. METHODS: A single-arm, open-label, multicenter trial was conducted in 17 hospitals in Japan. The eligibility criteria included histologically proven primary high-risk GISTs with macroscopic complete resection. Patients were treated with imatinib at a dose of 400 mg/day for 1 year after surgery. The primary endpoint was recurrence-free survival as assessed by Kaplan-Meier analysis. The secondary endpoints were overall survival and safety. This study was registered with ClinicalTrials.gov, number NCT00171977. RESULTS: A total of 64 patients were enrolled between September 2004 and July 2006. The median age of the patients was 59.5 years. Forty-nine (76.6%) patients completed the 1-year treatment, whereas 15 (23.4%) patients did not complete the treatment owing to recurrence, toxicities, and consent withdrawal. At the median follow-up period of 109 weeks, 20 patients had recurrence. The 3-year recurrence rate was 42.7% (95% confidence interval 29.2-56.3%), which exceeded the expected recurrence rate in this trial. The recurrence-free and overall survival rates at 2 years were 71.1 and 93.7%, respectively. The most frequent adverse drug reaction of any grade was eyelid edema (48.4%), followed by neutropenia (40.6%), leukopenia (39.1%), nausea (39.1%), rash (37.5%), and peripheral edema (37.5%), most of which were mild and manageable. CONCLUSIONS: Adjuvant therapy with imatinib at 400 mg/day for 1 year is well tolerated by Japanese patients and possibly reduces the risk of early recurrence of high-risk GISTs.
    Full-text · Article · Nov 2011 · International Journal of Clinical Oncology
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    ABSTRACT: The morphological distribution of tumor cells in metastatic lymph nodes has been investigated in positive sentinel lymph nodes in several solid cancers. The aim of this study was to clarify the effect of the distribution of metastatic foci in lymph nodes on the prognosis in gastric cancer. The distribution of metastatic foci in the 100 node-positive patients who had undergone curative gastrectomy were classified into two groups: (1) massive type, in which the tumor occupied the entire lymph node, and (2) non-massive type, in which the tumor did not occupy the entire lymph node. There were 38 patients in the massive type group and 62 patients in the non-massive type group. The 10-year survival rate was significantly poorer in the massive type group (p = 0.001). Multivariate analysis showed that distributional type and nodal status were independent prognostic factors. UICC N stage was subcategorized by distributional type, and survival was shown to be significantly worse in the massive type in the N1 group (p = 0.035). It seems necessary to take the morphological distribution of metastatic foci into consideration when dealing with node-positive patients who had received curative resection for gastric cancer.
    No preview · Article · Sep 2011 · Digestive surgery
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    ABSTRACT: A 62-year-old male patient underwent endoscopic mucosal resection (EMR). Additional hybrid 2-port hand-assisted laparoscopic surgery (HALS) (Mukai's operation) was performed for early rectal cancer located at the distal border of the rectum/below the peritoneal reflection (Rb) region [SM massive invasion/ly+/vertical margin (VM)X] via a small transverse incision, approximately 55 mm long, at the superior border of the pubic bone. After the pelvic floor muscles were dissected by laparoscopy-assisted manipulation, transanal subtotal intersphincteric resection (ISR) was performed under direct vision, securing a margin of more than 15 mm distal to the EMR scar. Partial external sphincteric resection (ESR) was also performed to obtain an adequate VM at the posterior region of the EMR scar. After bowel reconstruction, the layers were sutured transanally and a temporary covering colostomy was created. The resected specimen contained no residual tumor cells without lymph node metastasis. At 3 months after the operation, digital examination revealed good tonus of the anal muscles without stricture. The patient is currently undergoing rehabilitation of his anal sphincter muscles in preparation for the colostomy closure. In conclusion, subtotal ISR combined with partial ESR may decrease the need to perform Miles' operation for T1/2 stage I rectal cancer located at the distal border of the Rb region.
    Preview · Article · Sep 2011 · Oncology letters
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    ABSTRACT: Esophagojejunostomy with a circular stapling device is sometimes difficult to perform in a laparoscopic setting. On the other hand, a side-to-side anastomosis with a linear stapling device is technically challenging. Between June 2002 and March 2008, 10 consecutive patients underwent a laparoscopy-assisted total gastrectomy using a side-to-side anastomosis technique. Of these patients, four underwent a laparoscopy-assisted total gastrectomy with a modified anastomosis technique. A small wound was created on the antimesenteric side of the jejunum 5 cm distal to the resected portion and then in the lower esophagus. A peroral endoscope was advanced to the hole, and the cartridge fork was introduced into the lower esophagus under endoscopic guidance. The device (45 mm, blue) was fired to create an antiperistaltic side-to-side anastomosis. The common entry hole was closed by transecting the jejunum and the esophagus with another linear stapler and by using an endoscope as a stent. Four patients underwent the modified procedure and did not require an open procedure. One patient developed a pancreatic fistula, which was treated conservatively. The average operative time, reconstruction time and blood loss were 483 ± 133 minutes, 139 ± 31 minutes, and 199 ± 121 mL, respectively. An introduction of the stapler into the lower esophagus and a closure of the common entry hole were performed safely without any stress. Although several techniques must be compared to determine the ideal procedure for laparoscopic esophagojejunostomy, the modified side-to-side anastomosis technique may be useful in clinical settings.
    No preview · Article · Aug 2011 · Asian Journal of Endoscopic Surgery
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    ABSTRACT: The 5-year relapse-free survival rate (5Y-RFS) and the 5-year overall survival rate (5Y-OS) were calculated for 972 patients (stage I, 206 patients; stage II, 396 patients; stage III, 370 patients). We divided the stage III group into 259 patients with IIIa/N1 disease (≤3 positive nodes) and 111 patients with IIIb/N2 disease (≥4 positive nodes) according to the Japanese classification. The IIIa/N1 and IIIb/N2 categories were each subdivided into T1/2 (stage IIIa, 45 cases; IIIb, 9 cases) and ≥T3 (stage IIIa, 214 cases; IIIb, 102 cases) according to the TNM classification, and 5Y-RFS and 5Y-OS were compared between each subcategory and each group. The 5Y-RFS/5Y-OS values calculated for each stage were as follows: stage I, 94.0/90.7%; stage II, 80.5/81.1%; stage III, 63.5/65.7%. When stage IIIa was compared with IIIb, we obtained 67.9/72.0% for stage IIIa and 53.6% (p=0.001)/50.4% (p<0.001) for stage IIIb. For stage IIIa vs. IIIb in the ≥T3 category, we obtained 63.1/68.5% for stage IIIa and 51.9% (p=0.010)/49.0% (p=0.008) for stage IIIb. For stage IIIa vs. IIIb in the T1/2 category, we obtained 92.1/92.0% for stage IIIa and 72.9% (p=0.040)/63.5% (p=0.003) for stage IIIb. There were significant differences between T1/2 and ≥T3 within stage IIIa (p=0.001/p=0.009), but not within stage IIIb. These results suggest that the T1/2N1 category of colorectal cancer should be classified as a subcategory of stage IB/Ib rather than stage IIIA (TNM)/IIIa (Japanese classification).
    No preview · Article · Jul 2011 · Oncology Reports
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    ABSTRACT: The 5-year relapse-free survival rate (5Y-RFS) and 5-year overall survival rate (5Y-OS) were investigated in 766 patients with stage II/III colorectal cancer (CRC). The Stage II group included 283 patients with colon cancer (CC), 40 patients with rectosigmoid junction cancer (RSC), and 74 patients with rectal cancer (RC), while the Stage III group comprised 226 patients with CC, 52 patients with RSC, and 91 patients with RC. Stage III patients with RC were further divided into 68 patients with Ra cancer (Ra, rectum/above the peritoneal reflection) and 23 patients with Rb cancer (Rb, rectum/below the peritoneal reflection). Then the 5Y-RFS and 5Y-OS were calculated for each category or subcategory. The 5Y-RFS/5Y-OS was 80.3/80.6% for Stage II patients and 63.7% (p<0.001)/66.2% (p<0.001) for Stage III patients. In the Stage II group, the survival rates were 82.9/81.2% for CC, 77.6/74.8% for RSC, and 72.9/80.5% for RC, with no significant differences between each category. In the Stage III group, the survival rates were 69.3/72.8% for CC, 71.6/77.7% for RSC, and 46.5/46.2% for RC. There was no significant difference of survival for CC vs. RSC, but significant differences were noted for CC vs. RC (p<0.001/p<0.001) and RSC vs. RC (p=0.008/p=0.007). In the Stage III group, survival rates were 71.6/77.7% for RSC, 47.6/44.8% for Ra, and 45.7/51.3% for Rb, with significant differences for RSC vs. Ra (p=0.013/p=0.005) and RSC vs. Rb (p=0.026/p=0.180), but not for Ra vs. Rb. These results suggest that Stage II/III RS cancer should be classified as colon cancer and should not be considered an independent tumor type.
    Preview · Article · Jun 2011 · Oncology Reports
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    ABSTRACT: Pancreatic endocrine tumors (PETs) rarely involve the main pancreatic duct. We report a case of malignant nonfunctioning pancreatic endocrine tumor (NFPET) with prevalent intraductal growth. A 47-year-old woman was referred to us after ultrasonography at a routine health check showed diffuse swelling of the pancreas. Preoperative imaging showed a solid mass in the tail of the pancreas and a bulging intraductal mass in the main pancreatic duct. We performed total pancreatectomy because the tumor occupied almost the entire lumen of the main pancreatic duct. Histological examination confirmed well-differentiated endocrine carcinoma. We review reported cases of the intraductal growth of NFPETs and discuss the pathogenesis of these unusual tumors.
    No preview · Article · May 2011 · Surgery Today
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    ABSTRACT: Lymph nodes from patients with colorectal cancer were immunohistochemically stained for cytokeratin to investigate the relationship between the presence of occult neoplastic cells (ONCs) and recurrence/metastasis. A total of 80 patients with stage III/Dukes' C colorectal cancer were divided into 16 patients who developed recurrence/metastasis (recurrence group) and 64 patients without recurrence (non-recurrence group). ONCs were compared between the two groups with respect to i) single cells (≥ 3 floating ONCs), ii) clusters of cells (1 or more floating aggregates of 2-20 ONCs) and iii) single cells + clusters. When single cells were detected, the sensitivity for recurrence was 87.5% (14/16, p = 0.002), the positive predictive value (PPV) was 32.6% (14/43), the specificity was 54.7% (35/64) and the negative predictive value (NPV) was 94.6% (35/37). For clusters, the sensitivity was 87.5% (14/16, p<0.001), PPV was 41.2% (14/34), specificity was 68.8% (44/64) and NPV 95.7% (44/46). With single cells + clusters, the values were 87.5% (14/16, p<0.001), 48.3% (14/29), 76.6% (49/64) and 96.1% (49/51), respectively. These results suggest that the detection of single cells + clusters is a sensitive indicator of a high risk of recurrence/ metastasis, while ONCs are useful for identifying the low-risk group of patients with stage III colorectal cancer.
    No preview · Article · Feb 2011 · Oncology Reports

  • No preview · Article · Jan 2011 · Cancer Research
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    ABSTRACT: We report a patient who developed severe biliary stenosis after undergoing cholecystectomy and hepatoduodenal ligament lymph node dissection for early gallbladder cancer. A 43-year-old man underwent cholecystectomy for gallbladder cancer, developed postoperative biliary stenosis, and again underwent surgery involving bile duct resection. The pathological diagnosis for the bile duct wall was a fibrous scar with no evidence of malignancy; therefore, the biliary stenosis was presumably secondary to disruption of the bile duct blood supply caused by lymph node dissection.
    No preview · Article · Jan 2011 · Annals of Cancer Research and Therapy
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    ABSTRACT: Lymph nodes from patients with colorectal cancer were immunohistochemically stained for cytokeratin in order to investigate the relationship between the presence of occult neoplastic cells (ONCs) and recurrence/metastasis. A total of 78 patients with stage II/Dukes' B colorectal cancer were divided into two groups. The first group consisted of 18 patients who had developed recurrence/metastasis (recurrence group) and the other one of 60 patients who had survived without recurrence (non-recurrence group). The presence of ONCs was compared between the two groups with respect to i) single cells (≥3 floating ONCs), ii) clusters of cells (≥1 floating aggregates of 2-20 ONCs), and iii) single cells + clusters. When single cells were detected, the sensitivity for recurrence was 55.6% (10/18), the positive predictive value (PPV) was 30.3% (10/33), the specificity was 61.7% (37/60, p=0.195), and the negative predictive value (NPV) was 82.2%(37/45). For the clusters, the sensitivity was 55.6% (10/18), PPV was 37% (10/27), specificity was 71.7% (43/60, p=0.033), and NPV was 84.3% (43/51). With single cells + clusters, the values were 55.6% (10/18), 43.5% (10/23), 78.3% (47/60, p=0.006), and 85.5% (47/55), respectively. These results suggest that the detection of single cells + clusters has a high specificity and NPV, and indicates a low risk of recurrence/metastasis in patients with stage II colorectal cancer.
    No preview · Article · Jan 2011 · Oncology Reports
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    ABSTRACT: To develope a new procedure for laparoscopic exogastric resection using a so-called "fundic rotation technique (FRT)" for gastric submucosal tumors (SMTs) on the posterior wall near the esophagogastric junction (EGJ). Between April 2006 and February 2010, we performed laparoscopic resection for SMTs located near the EGJ (within 3.0 cm from the EGJ) in ten consecutive patients. Out of seven exogastric resections, an FRT was used in five patients with posterior tumors near the EGJ. The patients comprised three men and two women, with an average age of 65 years. The maximum tumor diameter averaged 3.8 cm (range, 2.0-8.0 cm), and the average distance from the EGJ was 1.5 cm (range, 0-2.5 cm). The pathological diagnosis was GIST in all cases. One case was converted to an open surgery due to its large size (8.0 cm) and the difficult access. All the patients quickly returned to their normal activities. No patient complained any symptoms of regurgitation, and endoscopic examination revealed no remarkable reflux esophagitis. No tumor recurrences occurred during a median follow-up period of 30 months. The indications for laparoscopic resection of SMTs located near the EGJ may be extended using an FRT.
    No preview · Article · Jan 2011 · The Tokai journal of experimental and clinical medicine
  • Mari Morita · Kyoji Ogoshi
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    ABSTRACT: Our clinical data accumulated during 30 years of clinical practice at the Department of Gastroenterological Surgery, Tokai University, indicated the effectiveness of the Billroth 1 procedure that preserve duodenal food passage, as well as its suppressive effect on hepatic metastasis. Here, the effectiveness of food passage through the duodenum is examined via experiments using BALB/c mice. Methods: In the first phase, gastrojejunostomy was performed using BALB/c mice. In the second phase, by duodenum ligation or not, the non-duodenal passage and duodenal passage models, respectively, were created. Transplantable colon26 was transplanted into the spleen, and the number of hepatic metastases was examined. At the same time, Kupffer cells, NK cells, Th1 cytokines, and Th2 cytokines such as IL-12, INFγ, and IL-4 were measured in the sham operation mice. Results: (1) Hepatic metastasis was observed in 9 of 25 mice (36.0%) and 18 of 26 mice (69.2%) in the duodenum passage model and non-duodenum passage model, respectively (p = 0.017, RR = 4.000, 95%CI, 1.246-12.842), and the average numbers of metastasis were 0.76 and 3.12, respectively (p = 0.077). (2) No significant differences were observed in the number of Kupffer cells and NK activity, and the production of Th1 cytokines and Th2 cytokines between the two groups. Conclusion: It was considered that in non-duodenum passage reconstructive surgery that produced bacterial translocation due to the existence of a blind loop may have induced cytokine production, causing the activation of NK cells and leading eventually to hepatic metastasis.
    No preview · Article · Jan 2011 · Annals of Cancer Research and Therapy

  • No preview · Article · Jan 2011 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: This study examined quality of life (QOL) and illness perceptions in Dutch and Japanese patients with non-small-cell lung cancer, thereby extending the body of knowledge on cultural differences and psychosocial aspects of this illness. 24 Dutch and 22 Japanese patients with non-small-cell lung cancer filled out questionnaires on three occasions: immediately before chemotherapy, 1 week later, and 8 weeks after the initial chemotherapy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) assessed QOL, and the Brief Illness Perception Questionnaire (B-IPQ) illness perceptions. Scores on several QOL measures indicated (a) major impact of first chemotherapy sessions, and (b) some tendency to returning to baseline measures at 8 weeks. Differences between Japanese and Dutch samples were found on five EORTC QLQ-C30 dimensions: global health status, emotional functioning, social functioning, constipation, and financial difficulties, with the Dutch patients reporting more favorable scores. Regarding illness perceptions, Japanese patients had higher means on perceived treatment control and personal control, expressing a higher sense of belief in the success of medical treatment than Dutch patients. In both Japanese and Dutch patients, impact of chemotherapy on QOL was evident. Some differences in illness perceptions and QOL between the two samples were observed, with implications for integral medical management. Both samples reported illness perceptions that reflect the major consequences of non-small-cell lung cancer. Incorporating symptom reports, illness perceptions, and QOL into medical management may have positive consequences for patients with non-small-cell lung cancer.
    Full-text · Article · Oct 2010 · Lung cancer (Amsterdam, Netherlands)

Publication Stats

739 Citations
185.10 Total Impact Points

Institutions

  • 1982-2013
    • Tokai University
      • • Department of Gastroenterological Surgery
      • • Department of Surgery
      • • School of Medicine
      Hiratuka, Kanagawa, Japan
  • 1995
    • Gunma University
      • Department of Surgery
      Maebashi, Gunma Prefecture, Japan
  • 1973
    • Kawasaki Saiwai Hospital
      Kawasaki, Fukuoka, Japan