Tsuyoshi Maeda

Combined Effect of Opioids and Corticosteroids for Alleviating Dyspnea in Terminal Cancer Patients: A Retrospective Review.

ABSTRACT Dyspnea is a prognostic factor that affects the quality of life of terminal cancer patients, and many reports have described opioid treatment for dyspnea alleviation. Here, we retrospectively evaluated differences in the effects of various opioids administered concomitantly with corticosteroids on dyspnea in 20 terminal-stage cancer patients (13 men, 7 women; mean age [range]: 71 [49–94] years) who received opioids concomitantly with corticosteroids. Effectiveness was assessed throughout administration using the Support Team Assessment Schedule, Japanese version (STAS-J), particularly the subscale indicating how strongly a patient is affected by symptoms. The effectiveness of combined opioid and corticosteroid therapy against dyspnea and the opioid dose comprised the primary and secondary foci, respectively. Among concomitantly treated patients, STAS-J scores at initiation (mean ± SD: 3.1 ± 0.24) and lowest recorded STAS-J scores (1.4 ± 0.22) differed significantly (P = .0034) among those receiving morphine, but not among those receiving oxycodone (P = .068) or fentanyl (P = .18). Concomitant opioid and corticosteroid treatment was associated with a ≥2-point STAS-J score improvement in 14/20 patients (effectiveness: 70%). The opioid dose did not significantly affect dyspnea alleviation. We conclude that concomitant opioid and corticosteroid treatment can effectively alleviate dyspnea in terminal cancer patients.

Dyspnea-alleviating and survival-prolonging effects of corticosteroids in patients with terminal cancer

In patients with cancer, dyspnea, which serves as a prognostic factor, increases toward the end of life. Notably, corticosteroid treatment can alleviate dyspnea in this patient population. Therefore, it is important to investigate the effects of corticosteroid responsiveness on patient survival. Accordingly, we retrospectively evaluated these effects and the efficacy of corticosteroids for dyspnea alleviation in patients with terminal cancer. Patients for whom corticosteroid therapy was or was not effective were designated as responders or non-responders, respectively, and survival was compared among patients in both groups. The primary endpoint was patient survival, and the secondary endpoints were the incidence of adverse effects and the effect of combination medicine use on responses to corticosteroids. From January 2012 through December 2015, 52 patients were investigated, and 30 and 22 were classified as responders and non-responders, respectively. Survival significantly increased among responders, compared to that among non-responders (8.5 vs. 5.0 days, P = 0.0019, Mann–Whitney U-test), although the average corticosteroid daily doses (in prednisolone equivalents) did not differ significantly (28.96  ±  12.83 and 29.13  ±  18.48 mg among responders and non-responders, respectively; P = 0.75, unpaired t-test). Observed corticosteroid-related side effects included insomnia (15.4%), delirium (11.5%), and hyperglycemia (3.8%). We attribute the survival difference to responsiveness to corticosteroids, as opposed to differences in patient prognosis related to underlying disease processes that resulted in apparent responses to medication. Our results suggest that further research is needed to evaluate the clinical factors related to corticosteroid combination therapy.

Retrospective analysis of corticosteroid doses administered to patients with terminal cancer for dyspnea alleviation and survival

Dyspnea negatively affects the survival and quality of life of patients with terminal cancer. Although corticosteroids are currently used to treat dyspnea, the association between corticosteroid dosage and survival remains unclear. This retrospective study was conducted to determine the relationship betweencorticosteroid doses, administered to hospitalized patients with terminal cancer for dyspnea alleviation, and survival. Subsequently, we investigated the associations between corticosteroid doses, which were classified into three categories, and the length of survival in days after stratifying 52 patients treated between January 2012 and December 2015 into corticosteroid responders and non-responders. The mean daily corticosteroid doses were 28.68 ± 14.4 mg for responders and 29.13 ± 18.5 mg for non-responders. The mean corticosteroid doses on the first day were 27.86 ± 14.9 mg for responders and 27.73 ± 19.5 mg for non-responders. The mean total corticosteroid doses administered during the first 2 days of treatment were 56.84 ± 29.2 mg for responders and 57.16 ± 38.5 mg for non-responders. The mean survival was 11.33 ± 7.5 days and 5.27 ± 3.35 days among responders and non-responders, respectively. In conclusion, the administration of corticosteroid for dyspnea alleviation did not correlate with survival. However, reactivity to corticosteroids increased the duration of corticosteroid use, which may have contributed to survival.

Range of Effective Corticosteroid Doses for Alleviating Dyspnea in Terminal Cancer Patients: A Retrospective Review

ABSTRACT This study aimed to determine the range of mean cumulative corticosteroid doses that could effectively palliate dyspnea in opioid-treated patients with terminal cancer and to investigate the demographic or biochemical factors predictive of corticosteroid responsiveness. To this end, responders and nonresponders were compared with regard to corticosteroid dose and whether they had initiated opioid use before or concomitantly with corticosteroid use. A logistic regression analysis was conducted to assess the impacts of demographic and biochemical factors on corticosteroid effectiveness. The final sample comprised 20 patients who satisfied the selection criteria. The responders accounted for 70% of the total sample (n = 14) and experienced the strongest effect with regard to dyspnea palliation at a mean cumulative dose equivalent to 64.4 mg prednisolone. However, no factors predictive of response were identified. In summary, this retrospective study identified effective corticosteroid doses for dyspnea alleviation in terminal cancer patients. Although our study sample was limited in size, the results support further prospective research.

Effect of administered corticosteroids for alleviating dyspnea in patients with terminal cancer: a prospective observational approach

Our primary objective was to prospectively evaluate the effects of corticosteroids on dyspnea in terminal cancer patients at Kasugai Municipal Hospital using the Japanese version of the Support Team Assessment Schedule (STAS-J). Our secondary objective was to report the side effects of corticosteroid use in these patients. The prospective investigation included two female patients with terminal breast cancer (Patients 1 and 2, ages 53 and 57 years, respectively) who satisfied the consecutive selection criteria and were hospitalized at Kasugai Municipal Hospital between January 2016 and March 2017. We used both interviews and a review of clinical records to evaluate these patients’ responses to oral or intravenous corticosteroid therapy for dyspnea. Patient 1 had an initial STAS-J dyspnea scale score of 4 before the commencement of corticosteroid administration, which decreased to scores of 2 (day 1) and 1 (day 2 and day 3) after corticosteroid administration. Patient 2 had an initial STAS-J scale score of 3, which decreased to 1 on day 1 and was maintained at this level until death occurred on day 15. Both patients experienced rapid relief of dyspnea (within 24 hours), indicating that corticosteroids may be used to effectively treat early dyspnea experienced by terminal cancer patients.

Corticosteroids for alleviating dyspnea in patients with terminal cancer

Dyspnea is a common symptom in patients with cancer, particularly those with advanced disease. Although corticosteroids can provide effective symptom relief to such patients, the effects of these drugs on dyspnea have not been evaluated. Therefore, we retrospectively evaluated the effect of corticosteroids on dyspnea in patients with terminal cancer through a surrogate third-party evaluation intended to overcome the difficulties of self-evaluation. We investigated the electronic medical records of 693 patients who were hospitalized at Kasugai Municipal Hospital between January and December 2015 and subsequently died. After excluding patients whose deaths were not directly cancer-related and 214 patients remained eligible, 19 of 34 remaining patients with dyspnea were ultimately included in the survey. Eleven patients in the final sample received corticosteroid treatment. Among the 11 patients who received corticosteroids, 9 (81.8%), 1 (9.1%), and 1 (9.1%) received betamethasone, dexamethasone, and prednisolone. The expression of the intended effect was observed in 6 of 11 patients in the steroid group. The median time to effect expression in the steroid group was 2 days. The median durations of effect in the steroid group were 3 days. After eliminating the opioid effect, we confirmed that steroid administration improved patients’ STAS-J scores and possibly alleviated dyspnea.

Effectiveness of Corticosteroid Monotherapy for Dyspnea Relief in Patients with Terminal Cancer

ABSTRACT Dyspnea is a common symptom in patients with cancer, particularly those with late-stage terminal disease. It markedly affects terminal cancer patients, reducing their quality of life. Reduced quality of life also affects survival; therefore, dyspnea is a prognostic factor. However, the role of corticosteroids, which often are used to alleviate dyspnea, has not been sufficiently validated. In this study, we retrospectively investigated whether corticosteroid monotherapy was effective for dyspnea palliation. The effectiveness rate of corticosteroid therapy was 45% in nine male and two female study subjects (mean age: 74.5 years; range: 64–86 years). No significant differences were found between responders and nonresponders in the first-day corticosteroid doses (25.5 ± 10.86 vs. 36.1 ± 16.39 mg, P = .29) or doses administered on 2 days (47.7 ± 25.99 vs. 72.2 ± 32.78 mg, P = .25). The mean ± standard error assessment score changed significantly from 2.7 ± 0.14 at the beginning of corticosteroid administration to 1.5 ± 0.37 at the time of maximum effect (P = .028); however, the decrease to 2.1 ± 0.25 at the final administration was not significant (P = .068). This indicates that corticosteroid therapy relieved dyspnea and could provide an early-stage treatment option.

Examination of Factors Affecting Efficacy of Oral Branched Chain Amino Acids in a Retrospective Study

Oral branched chain amino acid preparations consisting of three branched chain amino acids are used for the treatment of decompensated liver cirrhosis associated with hypoalbuminemia which occurs in spite of a sufficient intake in food. In order to evaluate the efficacy of oral branched chain amino acids, we investigated their effect in patients with liver cirrhosis, focusing on blood platelet levels. We analyzed the relationship between blood platelet counts and severity score, serum albumin concentration, total bilirubin concentration and prothrombin time.Our subjects were 13 patients with decompensated liver cirrhosis (1 female and 12 males, mean age 60.8 years). In patients with blood platelet counts of more than 10×104/μL, serum albumin concentration and severity score were significantly improved by the oral administration of branched chain amino acids. On the other hand, total bilirubin concentration and prothrombin time were not significantly changed by orally administered branched chain amino acids in patients with blood platelet counts of more than 10×104/μL and also when they were under 10×104/μL.These results suggest that classifying patients based on blood platelet levels might be useful in evaluation of the efficacy of oral branched chain amino acids, and doing this in addition to working out severity scores would be valuable in ensuring the proper use of oral branched chain amino acids.

Retrospective Study on Adverse Reactions Occurring during Interferon-ribavirin Combination Therapy and Revision of Pamphlet on the Therapy to Give a Fuller Explanation of Adverse Reactions

Interferon-ribavirin combination therapy is the mainstay treatment for chronic hepatitis C today. In view of its very common use, we investigated the adverse drug reactions through a retrospective review of medical records of chronic hepatitis C patients who underwent such therapy. We also determined their current condition by investigating hemoglobin levels, white blood cell counts and platelet counts.Subjects were 20 chronic hepatitis C patients (7 females and 13 males, mean age 53.6 years) who were hospitalized in the Department of Gastroenterology of Kasugai Municipal Hospital to undergo interferon-ribavirin combination therapy. Ten patients were classified as HCV serotype 1, and 10 as HCV serotype 2. Four patients discontinued the therapy. Bloodtests showed that the rate at which hemoglobin levels, white blood cell counts and platelet counts decreased tended to belower than before treatment.No notable adverse drug reactions were observed in this study, those that did occur were similar to those seen with interferon monotherapy and with the exception of muscle pain, there were no significant differences. However, many individualdifferences were seen in terms of severity, time of onset and duration of symptoms. This confirmed the need for guidanceto be geared towards individual patients. Based on the results of our investigation, we revised our brochure on interferonribavirin combination therapy to give a fuller explanation of the adverse reactions. We feel that it is very important for patients to have a good understanding of the possible adverse reactions beforehand and to make an adequate response whenthey occur during therapy.

A Study on the Side Effects of Interferon Therapy Based on a Medical Report of Chronic Hepatitis C and the Development of a New Pamphlet to Describe the Side Effects of this Therapy.

The side effects were determined based on medical reports from 17 patients with chronic hepatitis type C who were admitted to a hospital in order to receive interferon (IFN) therapy. A pamphlet to explain the side effects was made by referring to the results of this investigation at the same time. All patients complained of fever. Two patients stopped the IFN therapy. In addition, the follow side effects have been reported in the literature; arthralgia, muscular pain, digestive system symptoms, eruptions, and sleeplessness.By investigating the period and length of time for such side effects caused by IFN therapy, we found a large number of side effects with the most frequent being fever due to IFN treatment. The occurrence of slight fever and general fatigue was immediately after IFN medication and tended to continue for a long period of time. The fever and the malaise reappeared after a fixed period during this investigation. Our findings helped us to accurately describe the side effects.In particular, patients undergoing long term IFN treatment tend to develop unique side effects. In conclusion, patients treated with IFN need to clearly understand what side effect, they can expect to experience during the course of therapy.