Hiroko Komatsu

Cross-sectional analysis of germline BRCA1 and BRCA2 mutations in Japanese patients suspected to have hereditary breast/ovarian cancer.

The prevalence of BRCA1/2 germline mutations in Japanese patients suspected to have hereditary breast/ovarian cancer was examined by a multi‐institutional study, aiming at the clinical application of total sequencing analysis and validation of assay sensitivity in Japanese people using a cross‐sectional approach based on genetic factors estimated from personal and family histories. One hundred and thirty‐five subjects were referred to the genetic counseling clinics and enrolled in the study. Full sequencing analysis of the BRCA1/2 gene showed 28 types of deleterious mutations in 36 subjects (26.7%), including 13 types of BRCA1 mutations in 17 subjects (12.6%) and 15 types of BRCA2 mutations in 19 subjects (14.1%). Subjects were classified into five groups and 22 subgroups according to their personal and family history of breast and/or ovarian cancer, and the prevalence of deleterious mutations was compared with previously reported data in non‐Ashkenazi individuals. Statistical analysis using the Mantel‐Haenszel test for groups I through IV revealed that the prevalence of Japanese subjects was significantly higher than that of non‐Ashkenazi individuals (P = 0.005, odds ratio 1.87, 95% confidence interval 1.22–2.88). Family history of the probands suffering from breast cancer indicated risk factors for the presence of deleterious mutations of BRCA1/2 as follows: (1) families with breast cancer before age 40 within second degree relatives (P = 0.0265, odds ratio 2.833, 95% confidence interval 1.165–7.136) and (2) families with bilateral breast cancer and/or ovarian cancer within second degree relatives (P = 0.0151, odds ratio 2.88, 95% confidence interval 1.25–6.64). (Cancer Sci 2008; 99: 1967–1976)

Guided Self-Help for Prevention of Depression and Anxiety in Women with Breast Cancer

Depression and anxiety are prevalent in women with breast cancer. We developed a self-help kit as a self-learning package of necessary preparatory information (basic knowledge on chemotherapy, side effects, and problem-solving skills). We provided an oncology nurse-guided self-help kit with a cognitive behavioral therapy approach to 46 women with breast cancer in the intervention group and usual care to 36 in the control group in outpatient chemotherapy settings. The oncology nurse monitored and facilitated the patients progress using the diary during the patients chemotherapy. We also provided professional-led support group programs. Depression, anxiety, and quality of life were measured at baseline, 1 week, 3 months, and 6 months. The chi-square test and t were used to examine differences between the two groups, and repeated measures analysis of variance was used to test the effects of the intervention on the measures over time. All depression and anxiety scores were improved in both the intervention and control groups, but there were no significant differences between the two groups. Further studies are needed to evaluate the effectiveness of an oncology nurse-guided self-help approach for cancer patients.

Information Sharing and Case Conference Among the Multidisciplinary Team Improve Patients' Perceptions of Care

Background: As the advent of genomic technology accelerates personalized medicine and complex care, multidisciplinary care is essential for management of breast cancer. Objectives: To assess whether healthcare delivery systems are related to patients’ perceptions of care in breast cancer treatment institutions. Methods: We conducted a cross-sectional nationwide study of breast cancer treatment institutions approved by the Japanese Breast Cancer Society in Japan. From 128 of the 457 institutions, 1,206 patients were included in the analysis. Each patient completed a questionnaire regarding perceptions of care that consisted of a multidisciplinary care subscale and a patient-centered care subscale. Results: Multiple regression analysis revealed that the multidisciplinary care subscale was significantly related to implementation of patient-based medical record system that was paper-based (p<0.05). The results of the secondary analysis showed a significant relationship between the interdepartmental medical record system and the patient’s perception of multidisciplinary care (p<0.05) and patient-centered care (p<0.05). When a multidisciplinary case conference took place regularly or multidisciplinary viewpoints were incorporated into the conference records, the conference had a significantly higher correlation with both subscales (p<0.001). Conclusions: Integrated patient-based information and regular multidisciplinary case conferences that include records of viewpoints from different professionals improve patients’ perceptions of comprehensive breast cancer care.

Comparison of the Hospice Systems in the United States, Japan and Taiwan

PURPOSE The aim of hospice care is to provide the best possible quality of life both for people approaching the end of life and for their families and carers. The Korean government has been implementing a pilot project for hospital hospice services and trying to develop the national hospice system. To assist in the development of the Korean hospice system, the Korean government supported the present study comparing the hospice systems of three countries, United States, Japan, and Taiwan, which currently have a developed hospice system. METHODS Data from three countries were collected in the following ways: reviewing hospice related literature, searching government documents on the Internet, collecting government hospice data, surveying six hospice institutions in each country, and conducting an international workshop. RESULTS The hospice system was evaluated by comparing hospice management systems and hospice cost systems. The comparison of the hospice management system included five items of hospice infra structures and four items of hospice services. The hospice cost system included four items: funding source, hospital hospice cost, day care hospice cost, and home hospice cost. CONCLUSIONS Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea, which has been implementing a pilot project only for hospital hospice services.

Mapping unmet supportive care needs, quality-of-life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: results from the International STEP Study

Background To assess the supportive care needs, quality of life (QoL) and symptoms of patients with cancer after the end of first-line treatments and into survivorship in Asian countries using Australian data as benchmark. Patients and methods A cross-sectional survey was carried out in Australia and eight high-income (HICs) and low-/middle-income (LMICs) Asian countries (China, Japan, Hong Kong SAR, South Korea, Myanmar, Thailand, India, Philippines) using validated scales (Cancer Survivors Unmet Needs scale), physical-symptom concerns (Cancer Survivors Survey of Needs subscale) and a single-item measure of global QoL perception. Results Data were collected from 1748 patients from nine countries. QoL was highest in Australia and all other countries had significantly lower QoL than Australia (all P < 0.001). One-quarter of the patients reported low QoL (scores 1-3/10). The most frequently reported symptoms were fatigue (66.6%), loss of strength (61.8%), pain (61.6%), sleep disturbance (60.1%), and weight changes (57.7%), with no difference in symptom experience between Australian data and all other countries, or between HICs and LMICs. Unmet needs of moderate/strong level were particularly high in all aspects assessed, particularly in the area of existential survivorship (psychosocial care) and receiving comprehensive cancer care. Australia and HICs were similar in terms of unmet needs (all low), but LMICs had a significantly higher number of needs both compared with Australia and HICs (all P < 0.001). Conclusion Health care systems in Asian countries need to re-think and prioritize survivorship cancer care and put action plans in place to overcome some of the challenges surrounding the delivery of optimal supportive cancer care, use available resource-stratified guidelines for supportive care and test efficient and cost-effective models of survivorship care.

Inner conflict in patients receiving oral anticancer agents: a qualitative study

Objectives To explore the experiences of patients receiving oral anticancer agents. Design A qualitative study using semistructured interviews with a grounded theory approach. Setting A university hospital in Japan. Participants 14 patients with gastric cancer who managed their cancer with oral anticancer agents. Results Patients with cancer experienced inner conflict between rational belief and emotional resistance to taking medication due to confrontation with cancer, doubt regarding efficacy and concerns over potential harm attached to use of the agent. Although they perceived themselves as being adherent to medication, they reported partial non-adherent behaviours. The patients reassessed their lives through the experience of inner conflict and, ultimately, they recognised their role in medication therapy. Conclusions Patients with cancer experienced inner conflict, in which considerable emotional resistance to taking their medication affected their occasional non-adherent behaviours. In patient-centred care, it is imperative that healthcare providers understand patients’ inner conflict and inconsistency between their subjective view and behaviour to support patient adherence.

Repair of the threatened feminine identity: Experience of women with cervical cancer undergoing fertility preservation surgery

Background: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. Objective: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. Methods: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. Results: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women’s feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. Conclusions: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. Implications for Practice: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients’ needs and provide appropriate individual care.

Are we ready for personalized cancer risk management? The view from breast-care providers

Personalized medicine, the tailoring of prevention and treatment, is the future of routine clinical practice. This approach has started to appear in genetic testing for predisposition to hereditary breast and ovarian cancer (HBOC). We explored how breast-care providers perceived HBOC risk management, using grounded theory. This study found that the frontline healthcare providers perceived HBOC risk management as still being neglected in breast cancer care. Emerging challenges included treatment priority, hesitancy to deal with sensitive issues, easily missed risks, genetic data not being shared among multidisciplinary professionals, and patients being lost to follow-up. Oncology nurses are ideally placed to facilitate communication and utilization of genetic information among multidisciplinary professionals. Specialized outpatient clinics need to be established to follow up individuals at high risk. There is a need to create a system to meet the future demands of personalized medicine in nursing practice.

Effectiveness of a stress management program to enhance perimenopausal women's ability to cope with stress

AIM To evaluate the effectiveness of a stress management program to enhance the ability to cope with stress in perimenopausal women. METHODS In this quasi-experimental design, a stress management program was provided to an experimental group (n = 55), while a control group (n = 42) was given an informational pamphlet. The stress management program included a short lecture, group discussion, and hands-on training in 2 h sessions once a week for 3 weeks. Participants were recruited through a public announcement. Data were collected before and after the intervention, and 1 month following the intervention. The ability to cope with stress was the primary outcome, while psychological well-being and relief of symptoms were the secondary outcomes. The primary purpose of this program is to enhance the ability to cope with stress. Therefore, the aspects of knowledge, coping flexibility, and manageability were measured in the resultant ability to cope with stress. RESULTS Compared to the control group, knowledge in the experimental group improved positively as the primary outcome (P < 0.01). Changes in coping flexibility were demonstrated within the experimental group (P < 0.05). A comparison between groups for the secondary outcome of psychological well-being showed that personal growth (P < 0.05) and happiness (P < 0.01) significantly improved in the experimental group. In addition, the secondary outcome of relief of symptoms indicated not improved. CONCLUSION Results suggest that the stress management program has the potential to boost perimenopausal womens ability to cope with stress and improve their psychological well-being.

Preparing for a paradigm shift in aging populations: listen to the oldest old

ABSTRACT Purpose: Current healthcare systems are not suitable for serving future societies in which the oldest old are commonplace. The objective of this study was to understand what the oldest old care most about in their daily lives. Methods: Semi-structured in-depth interviews and thematic analysis were used. Face-to-face interviews were conducted in 17 elderly residents (≥ 95 years) of Arakawa-ku, Tokyo, Japan from July to November 2017. Results: Three themes emerged from the interview responses: “unshakable beliefs and social ties,” “natural acceptance,” and “my day-to-day life with precious moments.” The oldest old strongly believe in diligence and compassion and maintain strong relationships with people around them. Despite their small social networks, they are concerned about future society. They accept their selves and their lives, including their impending deaths. Despite their functional decline, they control their lives by making very small decisions. They live on a moment-to-moment basis, cherishing simple events. Conclusion: Maintaining autonomy through making small decisions and enjoying small pleasures are important to the oldest old. Understanding the needs of the oldest old is the first step towards developing optimal geriatric care for an aging population.