Annual Report 2018
Department of Palliative Medicine
Yoshihisa Matsumoto, Tomofumi Miura, Yuko Uehara, Kazuhiro Kosugi, Yuko Usui, Rie Yamamoto, Yuki Sumazaki Watababe, Yujiro Inoue, Maika Natsume, Ayumi Okizaki, Hiroko Koga, Masako Ikeda, Sachiko Nagatsuma, Yoshiko Tomita
Introduction
The purpose of our department is to improve the quality of life of cancer patients and their family caregivers by management of irritable symptom burden and establishment of a regional palliative care system. Therefore, we provide 3 palliative care services: 1) outpatient clinic, 2) supportive care team and 3) palliative care unit.
Additionally, the National Cancer Center Hospital East was certified as an ESMO designated center of integrated oncology and palliative care in 2018.
Research activities
The aim of the research in our division is to establish a regional palliative care system and to integrate early palliative care with oncology. The following research is conducted:
1) System construction of screening and intervention for symptoms in patients with advanced cancer.
2) Development of the integration of early palliative care in metastatic lung cancer.
3) Development of an intervention for cancerrelated fatigue in advanced cancer patients with palliative care settings.
4) A survey about pain, fatigue and anorexia in advanced cancer patients with palliative care settings.
5) A survey about burden and distress in cancer patients who have children using an online peer support system.
6) A registration for Japanese multicenter cohort studies.
7) Development of a monitoring system to support advanced cancer patients with home palliative care.
8) Development of an evaluation tool of the nutritional status of cancer patients.
The Team and What We Do
1. Outpatient clinic
Patients with or without anti-cancer therapy consult our outpatient clinic about management of their symptoms or support to decide where and how to spend their lives. The concept of early palliative care has gradually spread and consultations with patients undergoing anticancer therapy have been increasing. (Table 1)
Table 1. Number of patients in outpatients clinic
2. Supportive care team
This team consists of physicians, psychooncologists, nurses, dieticians, physiotherapists and speech-language-hearing therapists. In the oncology section, our supportive care team take a multidisciplinary approach for inpatients with various illnesses.
3. Palliative care unit
Our palliative care unit is the Japanese version of an acute palliative care unit (APCU). The features of APCU are multidimensional assessment, rapid symptom control and intensive psychosocial care with shorter length of stay and lower death rate than in a traditional PCU.Medical social workers greatly contribute to the transition to palliative home care and transfers to other hospitals. (Table 2)
Table 2. Number of patients in PCU
Clinical trials
1) A multi-centered randomized control trial of the integration of early palliative care in metastatic lung cancer.
2) A multi-centered phase II trial of dexamethasone for cancer-related fatigue.
Education
The purpose is to promote understanding about palliative care in cancer patients and their families for residents. Residents can train in home palliative care on request. To disseminate knowledge about primary palliative care, we held several workshops for medical staff in NCCHE and for regional palliative care staff.
Future prospects
Our department will continue the above activities and develop new treatments or medical instruments to improve QOL in cancer patients and their family caregivers.
List of papers published in 2018
Journal
1. Miura T, Matsumoto Y, Kawaguchi T, Masuda Y, Okizaki A, Koga H, Tagami K, Watanabe YS, Uehara Y, Yamaguchi T, Morita T. Low Phase Angle Is Correlated With Worse General Condition in Patients with Advanced Cancer. Nutr Cancer, 71:83-88, 2019
2. Watanabe YS, Miura T, Okizaki A, Tagami K, Matsumoto Y, Fujimori M, Morita T, Kinoshita H. Comparison of Indicators for Achievement of Pain Control With a Personalized Pain Goal in a Comprehensive Cancer Center. J Pain Symptom Manage, 55:1159-1164, 2018
3. Ishiki H, Yamaguchi T, Matsumoto Y, Kiuchi D, Satomi E. Effect of early palliative care: complex intervention and complex results. Lancet Oncol, 19:e221, 2018
4. Kako J, Kobayashi M, Kanno Y, Ogawa A, Miura T, Matsumoto Y. The Optimal Cutoff Point for Expressing Revised Edmonton Symptom Assessment System Scores as Binary Data Indicating the Presence or Absence of Symptoms. Am J Hosp Palliat Care, 35:1390-1393, 2018
5. Tagami K, Okizaki A, Miura T, Watanabe YS, Matsumoto Y, Morita T, Fujimori M, Kinoshita H. Breakthrough Cancer Pain Influences General Activities and Pain Management: A Comparison of Patients with and without Breakthrough Cancer Pain. J Palliat Med, 21:1636-1640, 2018
6. Hamano J, Takeuchi A, Yamaguchi T, Baba M, Imai K, Ikenaga M, Matsumoto Y, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Tatara R, Watanabe H, Otani H, Nagaoka H, Mori M, Tei Y, Hiramoto S, Morita T. A combination of routine laboratory findings and vital signs can predict survival of advanced cancer patients without physician evaluation: a fractional polynomial model. Eur J Cancer, 105:50-60, 2018
7. Miura T, Amano K, Shirado A, Baba M, Ozawa T, Nakajima N, Suga A, Matsumoto Y, Shimizu M, Shimoyama S, Kuriyama T, Matsuda Y, Iwashita T, Mori I, Kinoshita H. Low Transthyretin Levels Predict Poor Prognosis in Cancer Patients in Palliative Care Settings. Nutr Cancer, 70:1283-1289, 2018
8. Yagi Y, Kosugi K, Tanimoto T. Randomized Phase III and Extension Studies of Naldemedine in Patients With Opioid-Induced Constipation and Cancer. J Clin Oncol, 36:1049-1050, 2018
9. Yagi Y, Kosugi K, Tanimoto T. Treatment Approaches for Malignant Pleural Effusion. JAMA, 319:1506-1507, 2018
10. Miura T, Mitsunaga S, Ikeda M, Ohno I, Takahashi H, Kuwata T, Ochiai A. Neural Invasion Spreads Macrophage-Related Allodynia via Neural Root in Pancreatic Cancer. Anesth Analg, 126:1729- 1738, 2018
11. Miura T, Mitsunaga S, Ikeda M, Ohno I, Takahashi H, Suzuki H, Irisawa A, Kuwata T, Ochiai A. Characterization of low active ghrelin ratio in patients with advanced pancreatic cancer. Support Care Cancer, 26:3811-3817, 2018