Yusuke Hiratsuka’s research while affiliated with Takeda Hospital Group and other places

Background: Cancer-related neuropathic pain (CR-NP) is challenging to manage, and the effectiveness of corticosteroids remains underexplored. Objectives: This study investigated the analgesic and functional benefits of corticosteroids in CR-NP. Methods: This multicenter, prospective observational study enrolled patients with CR-NP who initiated or escalated corticosteroid therapy. Pain intensity and daily activities were assessed at baseline (T0), 72 (T1), and 168 h (T2). A paired-sample t-test compared pain intensity changes. Linear regression analysis examined the association between changes in opioid daily dose and pain intensity, while Pearson’s correlation coefficient assessed the relationship between changes in daily activities and pain intensity. Results: In total, 107 patients were consecutively enrolled. The mean worst pain intensity decreased from 8.2 ± 1.9 at T0 to 5.2 ± 2.9 at T1 and further to 4.4 ± 3.0 at T2. No significant correlation was found between changes in opioid daily dose and pain intensity. However, daily activities improved significantly in correlation with pain reduction (r = −0.36, p < 0.01). Over 75% of patients reported satisfaction with CR-NP management. Adverse events occurred in 21 cases and were generally mild. Conclusions: Corticosteroids provided rapid and considerable analgesic and functional benefits for patients with CR-NP in this observational setting; further validation through comparative controlled studies is required.

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.

Background: Modified versions of the Objective Prognostic Score (mOPS) needs to be validated to reflect practical palliative care circumstances in Taiwan. Objectives: We compared the abilities of an mOPS score of 1.5 or higher versus a Karnofsky Performance Status (KPS) score of 30 or lower to predict 2-week mortality in patients with advanced cancer in Taiwan. Design: Observational study. Setting/Subjects: We performed a secondary analysis of an international multicenter cohort study of patients in East Asia. Participants were inpatients with advanced cancer in palliative care units (PCUs) in Taiwan. Measurements: We compared the mOPS-B model, which does not require laboratory tests, with the KPS in a 2-week survival timeframe. We compared the accuracy of the prognostic models using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Calibration plots and net reclassification indices (NRI) for 2-week survival were compared between the two models. Differences in survival between the higher- and lower-scoring groups of each model were identified using the log-rank test. Results: We included 317 patients, with a median survival of 14.0 days. The mOPS-B had a high sensitivity (0.82) and high AUROC value (0.69). By contrast, the KPS demonstrated good sensitivity (0.77) and an acceptable AUROC value (0.65) for predicting 2-week survival. The calibration plot did not demonstrate satisfactory agreement between the actual and predicted survival times in either the mOPS-B or the KPS groups. Our NRI was positive (absolute value: 22%), indicating that mOPS-B predicted 2-week survival better than KPS. Conclusions: The mOPS-B may serve better than the KPS as a screening tool for admission to PCUs in Taiwan because it was more accurate at predicting 2-week survival.

Objectives Achieving a ‘good death’ is one of the important goals of palliative care. Providing goal-concordant care and an environment tailored to the patient’s preferences can contribute to a ‘good death’. However, the concordance rate between the preferred and actual places of death among advanced cancer patients in Japan is less explored. This study aimed to identify the concordance between patients’ preferred and actual places of death and the associated factors among patients with advanced cancer in Japan. Materials and Methods Patients with advanced cancer who underwent chemotherapy at Tohoku University Hospital between January 2015 and January 2016 were enrolled and followed up for 5 years. The enrolled patients were asked about their preference for their place of death. The response options were: “Own home,” “General ward” and “Palliative care unit (PCU).” We compared the actual place of death with the patient’s preference through a follow-up review of the medical records. Results A total of 157 patients with advanced cancer were enrolled between January 2015 and January 2016. Of these patients, 22.9% (11/48) died at home according to their preference, 64.0% (16/25) in the general ward and 37.9% (11/29) in the PCU. Only thirty-seven (37.3%) patients died where they wanted, based on the comparison between patients’ preferences and actual places of death. Conclusion The concordance rate between the preferred and actual places of death is not high in Japan. Improving concordance between patients’ preferences and actual places of death has the potential to improve end-of-life care.

Background: Timely palliative transition in patients with advanced cancer is essential for their improved quality of life and overall survival (OS). Most prognostic models have been developed focusing on weeks’ survival. The current study aimed to compare the accuracies of several indicators, such as the Karnofsky Performance Scale (KPS), Clinicians’ Prediction of Survival (CPS), and Edmonton Symptom Assessment System (ESAS), for predicting the survival of patients. Methods: Two hundred patients were enrolled at a single tertiary cancer center in South Korea between 2016 and 2019. We compared the discrimination of CPS versus KPS and ESAS total scores using the area under the receiver operating characteristic curve (AUROC) in 3-month and 6-month survival predictions. Results: The median age of patients was 66.0 years, and 128 (64%) were male. Two-thirds (66%) of the patients had an Eastern Cooperative Oncology Group performance status of 0 or 1, and 55.5% had a KPS of 80% or higher. The values of AUROC of CPS, KPS, and ESAS total score in 3-month survival prediction were 0.80 (95% confidence interval [CI]: 0.73–0.88), 0.71 (95% CI: 0.62–0.79), and 0.71 (95% CI: 0.62–0.81), respectively, whereas those in 6-month survival were 0.82 (95% CI: 0.76–0.88), 0.70 (95% CI: 0.63–0.78), and 0.63 (95% CI: 0.55–0.71), respectively. Conclusion: CPS showed the highest accuracy in predicting 3- and 6-month survival, whereas KPS had an acceptable accuracy. Experienced clinicians can rely on CPS to predict survival in months. We recommend the use of KPS with CPS to assist inexperienced clinicians.

Purpose In this study, we aimed to evaluate the safety and effectiveness of naldemedine for treating opioid-induced constipation (OIC) in patients with advanced cancer, who are receiving palliative care, and particularly explored its early effects. Methods Palliative care teams and inpatient palliative care units across 14 institutions in Japan were included in this multicenter, prospective, observational study. Patients who were newly prescribed a daily oral dose of 0.2 mg naldemedine were enrolled. The spontaneous bowel movement (SBM) within 24 h after the first dose of naldemedine was considered the primary outcome, whereas, the secondary outcomes included weekly changes in SBM frequency and adverse events. Results A total of 204 patients were enrolled and 184 completed the 7-day study. The average age of the participants (103 males, 101 females) was 63 ± 14 years. The primary cancer was detected in the lungs (23.5%), gastrointestinal tract (13.7%), and urological organs (9.3%). A considerable proportion of patients (34.8%) had ECOG performance status of 3–4. Most patients were undergoing active cancer treatment, however, 40.7% of the patients were receiving the best supportive care. Within 24 h of the first naldemedine dose, 146 patients (71.6%, 95% CI: 65.4–77.8%) experienced SBMs. The weekly SBM counts increased in 62.7% of the participants. The major adverse events included diarrhea and abdominal pain, detected in 17.6% and 5.4% of the patients, respectively. However, no serious adverse events were observed. Conclusion Conclusively, naldemedine is effective and safe for OIC treatments in real-world palliative care settings. Trial registration number UMIN000031381, registered 20/02/2018.

Purpose Recent guidelines for prognostic evaluation recommend clinicians’ prediction of survival (CPS) for survival prediction in patients with advanced cancer. However, CPS is often inaccurate and optimistic. Studies on factors associated with overestimation or underestimation of CPS are limited. We aimed to investigate the factors associated with the overestimation and underestimation of CPS in patients with far-advanced cancer. Methods The current study was a secondary analysis of an international multicenter prospective cohort study, which enrolled newly admitted patients with advanced cancer in palliative care units (PCUs) in Japan, Korea, and Taiwan from 2017 to 2018. We obtained the temporal CPS at enrollment and performed multivariate logistic regression analysis to identify the factors associated with “underestimation (less than 33% of actual survival)” and “overestimation (more than 33% of actual survival).” Results A total of 2571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. Older age (adjusted odds ratio [aOR] 1.01; 95% confidence interval [CI] 1.01–1.02; P < 0.01) and reduced oral intake (aOR 0.68; 95% CI 0.51–0.89; P < 0.01) were identified as significant factors associated with underestimation. Dyspnea (aOR 1.28; 95% CI 1.06–1.54; P = 0.01) and hyperactive delirium (aOR 1.34; 95% CI 1.05–1.72; P = 0.02) were identified as significant factors associated with overestimation. Conclusion Older age was related to underestimation, while dyspnea and hyperactive delirium were related to overestimation of CPS for patients with weeks of survival. However, reduced oral intake was less likely to lead to underestimation.

Purpose Recent guidelines for prognostic evaluation recommend clinicians’ prediction of survival (CPS) for survival prediction in patients with advanced cancer. However, CPS is often inaccurate and optimistic. Studies on factors associated with overestimation or underestimation of CPS are limited. We aimed to investigate the factors associated with overestimation and underestimation of CPS in patients with far advanced cancer. Methods The current study was a secondary analysis of an international multicenter prospective cohort study, which enrolled newly admitted patients with advanced cancer in palliative care units (PCUs) in Japan, Korea, and Taiwan. We obtained the temporal CPS at enrollment and performed multivariate logistic regression analysis to identify the factors associated with underestimation and overestimation. Results A total of 2571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. Older age (adjusted odds ratio [aOR] 1.01; 95% confidence interval [CI] 1.01–1.02; P < 0.01) and reduced oral intake (aOR 0.68; 95% CI 0.51–0.89; P < 0.01) were identified as significant factors associated with underestimation. Dyspnea (aOR 1.28; 95% CI 1.06–1.54; P = 0.01) and hyperactive delirium (aOR 1.34; 95% CI 1.05–1.72; P = 0.02) were identified as significant factors associated with overestimation. Conclusion Older age was related to underestimation while dyspnea and hyperactive delirium were related to overestimation of CPS. However, reduced oral intake was less likely to lead to underestimation.