Tomohiro Nakaguchi

Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: prevalence, associated factors, and impact on quality of life.

The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short‐form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ‐C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients’ outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients’ needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596–2660)

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study

OBJECTIVE The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer. METHODS Patients aged ≥ 65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission. RESULTS Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16). CONCLUSIONS Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.

Perceived Needs, Psychological Distress and Quality of Life of Elderly Cancer Patients

OBJECTIVE Very few findings regarding the perceived needs of elderly cancer patients have been reported. This study investigated needs and psychological distress perceived by and/or quality of life of elderly cancer patients. METHODS Randomly selected ambulatory patients with cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexual); the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer QLQ-C 30. RESULTS Complete data were available for 619 cancer patients, including 113 subjects who were over 70 years old. The needs and the psychological distress perceived by the elderly patients were comparable with those perceived by relatively younger patients, although elderly patients perceived fewer sexual needs. Regarding the quality of life global health status, most symptom-related quality of life parameters were not significantly different between the two groups, while significant differences were observed with regard to several functional domains, including physical, emotional and social domains in addition to financial difficulties. CONCLUSIONS Only a few differences in the needs and the psychological distress perceived by patients existed between the elderly and the younger subjects, although some differences in the quality of life domains were noted, probably as a result of the influence of aging itself. Medical staff should provide elderly cancer patients with good clinical care similar to that provided to younger patients while considering the different impacts of aging on each quality of life dimension.

Clinical Indicators of Depression among Ambulatory Cancer Patients Undergoing Chemotherapy

OBJECTIVE This study aimed to investigate clinical indicators of depression among randomly selected ambulatory patients with cancer who were receiving chemotherapy. METHODS The patients were asked to complete the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer QLQ-C 30 and an ad hoc questionnaire regarding several additional common chemotherapy-related symptoms. RESULTS Complete data were available for 211 patients. Of the total, 13.7% patients experienced clinical depression. The presence of clinical depression was significantly associated with patient demographic characteristics (education level) as well as several symptoms such as the presence of pain, sleep disturbances, loss of appetite, nausea and fatigue. Multivariate logistic regression analysis indicated that a lower education level and the presence of pain were significantly associated with clinical depression. CONCLUSIONS These findings suggest that ambulatory cancer patients who are receiving chemotherapy and have pain and/or a lower education level have a higher probability of suffering from clinical depression; these factors may be useful for the early identification of depression in cancer patients.

Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians.

Background Decision-making capacity to provide informed consent regarding treatment is essential among cancer patients. The purpose of this study was to identify the frequency of decision-making incapacity among newly diagnosed older patients with hematological malignancy receiving first-line chemotherapy, to examine factors associated with incapacity and assess physicians’ perceptions of patients’ decision-making incapacity. Methods Consecutive patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Decision-making capacity was assessed using the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory-Revised (SICIATRI-R). Cognitive impairment, depressive condition and other possible associated factors were also evaluated. Results Among 139 eligible patients registered for this study, 114 completed the survey. Of these, 28 (25%, 95% confidence interval [CI]: 17%-32%) were judged as having some extent of decision-making incompetency according to SICIATRI-R. Higher levels of cognitive impairment and increasing age were significantly associated with decision-making incapacity. Physicians experienced difficulty performing competency assessment (Cohen’s kappa -0.54). Conclusions Decision-making incapacity was found to be a common and under-recognized problem in older patients with cancer. Age and assessment of cognitive impairment may provide the opportunity to find patients that are at a high risk of showing decision-making incapacity.

Good death for children with cancer: a qualitative study

OBJECTIVE This study aims to explore the characteristics of a good death for children with cancer. METHODS A total of 10 pediatric cancer survivors, 10 bereaved family members and 20 medical professionals participated in in-depth interviews. Qualitative content analysis was performed on the transcribed data obtained from semi-structured interviews. RESULTS Thirteen characteristics including unique and specific for children of a good death were identified: (i) sufficient opportunities to play freely, (ii) peer supporters, (iii) continued access to the patients usual activities and relationships, (iv) assurance of privacy, (v) respect for the patients decisions and preferences, (vi) a sense that others acknowledge and respect the patients childhood, (vii) comfort care to minimize distressing symptoms, (viii) hope, (ix) not aware of the patients own impending death, (x) constant dignity, (xi) strong family relationships, (xii) no sense of being a burden to family members and (xiii) good relationships with medical staffs. CONCLUSIONS This study identifies important characteristics of a good death for children with cancer. These findings may help medical staffs provide optimal care for children with cancer and their families, enabling them to achieve a good death.