Yujiro Kuroda

Communicating With Residents About Risks Following the Fukushima Nuclear Accident

The Fukushima nuclear accident in March 2011 posed major threats to public health. In response, medical professionals have tried to communicate the risks to residents. To investigate forms of risk communication and to share lessons learned, we reviewed medical professionals’ activities in Fukushima Prefecture from the prefectural level to the individual level: public communication through Fukushima Health Management Surveys, a Yorozu (“general”) health consultation project, communications of radiological conditions and health promotion in Iitate and Kawauchi villages, dialogues based on whole-body counter, and science communications through online media. The activities generally started with radiation risks, mainly through group-based discussions, but gradually shifted to face-to-face communications to address comprehensive health risks to individuals and well-being. The activities were intended to support residents’ decisions and to promote public health in a participatory manner. This article highlights the need for a systematic evaluation of ongoing risk communication practices, and a wider application of successful approaches for Fukushima recovery and for better preparedness for future disasters.

The importance of good death components among cancer patients, the general population, oncologists, and oncology nurses in Japan: patients prefer “fighting against cancer”

BackgroundThe objectives of this study were to compare the importance of components of a good death among cancer patients, the general population, oncologists, and oncology nurses, and explore which patients preferred “fighting against cancer.”MethodsWe conducted a cross-sectional anonymous self-reported survey of cancer patients who visited a radiation oncology outpatient clinic, oncologists, and oncology nurses at the Tokyo University Hospital and a random sample of the general population in the Tokyo metropolitan area. The outcomes were 18 previously developed components of a good death in Japanese cancer care consisting of 57 attributes.ResultsThree hundred ten patients, 353 subjects from the general population, 109 oncologists, and 366 oncology nurses participated. The desire to “fight against cancer” was highly significantly different between patients and oncologists (effect size [ES] = −1.40; P = 0.001) and patients and oncology nurses (ES = −1.12; P = 0.001). “Physical and cognitive control” was, similarly, highly significantly different between patients and oncologists (ES = −1.30; P = 0.001) and patients and oncology nurses (ES = −1.06; P = 0.001). Patients who emphasized “maintaining hope and pleasure” (P = 0.0001), “unawareness of death” (P = 0.0001), and “good relationship with family” (P = 0.004) favored “fighting against cancer.” The patients, however, who emphasized “physical and psychological comfort” did not significantly favor “fighting against cancer” (P = 0.004).ConclusionThe importance of good death components differed between groups. Medical professionals should be aware of the diversity of values surrounding death and assess the patient’s values and discuss them to support his or her quality of life. In addition, the development of care and a medical/social system to maintain hope and pleasure after failure of anticancer treatment is necessary.

Efficacy of Vitamin E Treatment for Hand-Foot Syndrome in Patients Receiving Capecitabine

Capecitabine is a novel oral fluoropyrimidine that is converted within tumor cells to fluorouracil by thymidine phosphorylase [1]. Hand-foot syndrome (HFS) is the most frequent side effect of capecitabine and has been reported in up to 71% of patients receiving a starting dose of 1,250 mg/m2 twice daily [2, 3, 4, 5, 6, 7]. Grade 3 HFS was reported in up to 10–24% of patients. Treatment interruption and, if required, dose reduction usually ameliorate symptoms without compromising efficacy [8, 9]. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve pain [10, 11]. Use of systemic corticosteroids, pyridoxine (vitamin B6), and cox-2 inhibitors have been used in patients developing HFS with cytotoxic agents including capecitabine and pegylated liposomal doxorubicin with varying success [11, 12, 13]. Kara et al. [13] from Turkey reported apparent benefit of vitamin E in managing HFS. Therefore we conducted this study to examine the efficacy of vitamin E in managing capecitabine-induced HFS. This retrospective, multicenter study was undertaken between 2005 and 2009 in HER2-negative patients with breast cancer treated with oral capecitabine 828 mg/m2 twice daily on days 1–21 every 4 weeks. Patients with symptoms of grade 2 HFS received oral vitamin E (Tocopherol Acetate, Eisai Pharmaceuticals, Tokyo, Japan) 100 mg/day without chemotherapy dose modification. Patient and treatment-related data, e.g. chemotherapy-related toxicities, dose of vitamin E, severity of symptoms, and tumor response to therapy, were recorded every 4 weeks. Patients underwent a complete der-matological examination at every visit. HFS including pain was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (NCI-CT-CAE v3.0). Wilcoxon signed rank test was used to examine patient demographics and treatment information. Median time to onset of grade 2 HFS was estimated. Severity of HFS was compared before and after vitamin E administration. We identified 32 patients developing grade 2 HFS during capecitabine therapy between January 2005 and February 2009, who subsequently received vitamin E with or without capecitabine treatment modification. The median time to first onset of HFS was 7.3 months (range 4.1–9.6). The initial starting dose of vitamin E for treatment of HFS was 100 mg/day, and the median dose of vitamin E was 200 mg (range 100–400 mg/day). Vitamin E application had a marked effect on dermatological complications within 7 days of initiation. The effect lasted throughout administration. Desquamation and pain reduced gradually (figs. ​(figs.1]1] and ​and2),2), and the comfort level of the patients improved. Fifteen of 32 patients (46.9%) with HFS experienced symptom improvement with vitamin E (100 mg/day) (p < 0.05; before vs. after 2 months vitamin E administration). Neurological symptoms improved. Thirteen patients still had pain, but this decreased after vitamin E dose escalation to 400 mg/day. The remaining 4 patients had considerable pain interfering with function after vitamin E 100 mg/day, but this reduced after vitamin E dose escalation to 400 mg/day and dose reduction of capecitabine as described previously [14]. Among all 32 patients included, the overall response rate to capecitabine was 37.5%, comprising 2 complete and 10 partial responses. Patients receiving capecitabine and vitamin E (100–400 mg) had longer time to progression than did patients receiving dose reduction of capecitabine (median 10.2 months vs. 6.1 months). Fig. 1 Hand-foot syndrome (HFS) began to disappear after 1 month of vitamin E treatment; 15 of 32 patients (47%) with HFS experienced symptom improvement with vitamin E (100 mg/day) (p < 0.05). Fig. 2 Clinical presentation of hand-foot syndrome. After vitamin E without dose reduction of capecitabine, the skin lesions had disappeared. In this retrospective study, 15 of 32 patients with HFS improved with vitamin E 100 mg/day, suggesting a beneficial effect of vitamin E therapy. Vitamin E is a widely used skin care product and functions as the major lipophilic antioxidant, preventing peroxidation of lipids and resulting in more stable cell membranes. The antioxidant membrane stabilizing effect of vitamin E also includes stabilization of the lysomal membrane, a function shared with glucocorticoids [13]. Systemic vitamin E and glucocorticoids inhibit the inflammatory response and collagen synthesis, thereby possibly impeding the

Chemotherapy with low-dose capecitabine as palliative treatment in a patient with metastatic breast cancer: a case report

Chemotherapeutic agents are rarely used for symptom management in patients under palliative care setting. This is because chemotherapeutic agents not only have limited efficacy in palliative treatment but are also known to exert severe adverse effects. We describe our experience with a patient with metastatic breast cancer who was successfully treated with low-dose capecitabine, without the development of any severe toxicities and with significant improvement in activities of daily living (ADL) and quality of life (QOL).The patient, a 43-year-old female, had breast cancer with liver, bone, and cutaneous metastases. She visited our clinic after a year-long hiatus during which she underwent alternative therapy. She presented with ulcerated lesions on the anterior chest and dyspnea due to malignant pleural effusion. After treatment for the latter, we administered capecitabine (600 mg/day) in accordance with the wishes of the patient and her attendants. The ulcerated lesions on the anterior chest, dyspnea, ADL and QOL improved significantly, without the development of any serious adverse effects. The findings of this case indicate that chemotherapy in the form of low-dose capecitabine monotherapy may be considered in patients under palliative care setting.

Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: a prospective cohort study

Purpose This study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake. Method This was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis. Results Of the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation. Discussion Renters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them.

Risk Factor for Incident Functional Disability and the Effect of a Preventive Exercise Program: A 4-Year Prospective Cohort Study of Older Survivors from the Great East Japan Earthquake and Nuclear Disaster

Objective: The aim of this study is to assess the risk factors for incident functional disability among long-term evacuees of Iitate village after Great East Japan Earthquake and nuclear disaster (GEJE). We also investigated the effectiveness of exercise classes as an intervention measure in this situation. Methods: 1159 subjects (75.2 ± 5.8 years, 57.5% female) were included at baseline, and followed-up for four years. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of incident functional disability according to the presence of risk factors evaluated by the municipality’s self-assessment Basic Checklist (BCL). Evacuees from Iitate who participated in the exercise classes and those who did not were matched using the propensity scores, which were then used to obtain the HR of incident functional disability. Results: New functional disability occurred in 280 (24.2%) participants during the follow-up. Participants who scored negative for the “Physical function” domain in the BCL had a HR of 2.04 (95% CI: 1.54–2.69) for incident functional disability when compared to those who scored positive for this domain. Similarly, the HR for “Cognitive function” was 1.37 (CI: 1.06–1.77), and 1.60 (CI: 1.24–2.08) for “Depression”. Using a Cox proportional hazard regression model, both the group with low-participation in the exercise program and the group with high-participation in the exercise program had a significantly lower rate of incident functional disability compared to those who did not participate at all (HR = 0.27, CI: 0.16–0.46; HR = 0.30, CI: 0.12–0.74, respectively). Conclusions: Pre-disaster BCL domains were useful to identify individuals at risk of functional disability after a major socio-technical disaster. Therefore, this instrument can be used to identify at-risk older adults who would benefit from early exercise programs to prevent incident functional disability.

Association between Health Literacy and Radiation Anxiety among Residents after a Nuclear Accident: Comparison between Evacuated and Non-Evacuated Areas

Following the accident at the Fukushima Nuclear Power Plant in March 2011, both experts and the national government provided insufficient information on radiation, leading to widespread distrust in the community. This study aimed at clarifying the association between anxiety about radiation and health literacy among residents in evacuation and non-evacuation areas in Fukushima. A questionnaire survey was sent to randomly sampled residents between August and October 2016, and data from 777 responses (38.9% valid response) were analyzed. The questionnaire assessed current radiation anxiety and discrimination and prejudice based on radiation exposure through seven items and communicative and critical health literacy through five items. Multiple regression analysis of the association between radiation anxiety and health literacy showed that the level of health literacy was significantly negatively associated with radiation anxiety in the evacuation areas (marginally in the non-evacuation areas) and marginally negatively associated with discrimination and prejudice in the evacuation areas but not in the non-evacuation areas. Therefore, improving health literacy could alleviate radiation anxiety.

Views on life and death of physicians, nurses, cancer patients and general population in Japan

This study aimed to investigate views on life and death among physicians, nurses, cancer patients, and the general population in Japan and examine factors affecting these views. We targeted 3,140 physicians, 470 nurses, 450 cancer patients, and 3,000 individuals from the general population. We used the Death Attitudes Inventory (DAI) to measure attitudes toward life and death. The collection rates were 35% (1,093/3,140), 78% (366/470), 69% (310/450), and 39% (1,180/3,000) for physicians, nurses, patients, and the general population, respectively. We found that age, sex, social role (i.e., physician, nurse, cancer patient, and general population) were significantly correlated with DAI subscales. Compared with general population, attitudes toward death of physicians, nurses and cancer patients differed significantly even after adjusted their age and sex. Our study is the first to analyze differences in views on life and death among physicians, nurses, cancer patients, and the general population in Japan.