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1. The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units

Author

Jiro Miyamoto, Hiroto Ishiki, Kaoru Nishijima, Masayuki Ikenaga, Kazuki Kitade, Natsuki Kawashima, Keiji Shimizu, Akira Inoue, Takeshi Hirohashi, Shuji Hiramoto, Hoshu Hashimoto, Yoichi Matsuda, Junko Nozato, Keisuke Kaneishi, Kosuke Kuwahara, Takashi Ohmori, Junichi Shimoinaba, Kengo Imai, Takehiro Nakai, Satoshi Inoue, Yosuke Matsuda, Toshihiro Yamauchi, Ritsuko Yabuki, Takahiro Higashibata, Rena Kamura, Satoru Tsuneto, Tetsuya Ito, Masaya Ehara, Eri Matsumoto, Ryo Matsunuma, Yoshihisa Matsumoto, Keiko Tanaka, Masanori Mori, Yuko Uehara, Toru Terabayashi, Yutaka Hatano, Yuki Sumazaki Watanabe, Teruaki Uno, Hirofumi Katayama, Yuto Unoki, Takayuki Hisanaga, Tomohiro Nishi, Akemi Shirado Naito, Hiroaki Tsukuura, Ayumi Okizaki, Koji Amano, Shingo Hagiwara, Tetsuo Hori, Tomonao Okamura, Satoko Ito, Yusuke Hiratsuka, Ko Sato, Takeya Yamaguchi, Tatsuya Morita, Hiromi Funaki, Yukari Azuma, Akihiro Sakashita, Hana Takatsu, Takuhiro Yamaguchi, Satoshi Miyake, Sayaka Maeda, Hideyuki Kashiwagi, Ryoichi Nakahori, Jun Nakagawa, Takashi Yamaguchi, Keita Tagami, Nanao Ishibashi, Yaichiro Matsumoto, Naosuke Yokomichi, Kiyofumi Oya, Shu Koito, Miho Shimokawa, Eriko Satomi, Kazuhiro Kosugi, Megumi Uchida, Yasuhiro Shibata, Tina Kamei, Jun Hamano, Akira Hayakawa, Takashi Ikee, Tetsuji Iriyama, Takuya Odagiri, Yu Uneno, Shunsuke Nakashima, Mitsunori Miyashita, Nao Ikuta, Takashi Kawaguchi, Yoshiyuki Kizawa, Mika Baba, Saran Yoshida, Tetsuya Yamagiwa, Isseki Maeda, Akira Yoshioka, Shohei Ueno, Yuta Ishiyama, Hiroyuki Kohara, Shunsuke Oyamada, Ayako Kikuchi, Hiroyuki Otani, Kozue Suzuki, Hiroaki Watanabe, Shunsuke Kosugi, Takeru Okoshi, and Tomofumi Miura

Subjects
medicine.medical_specialty, Nutrition and Dietetics, Palliative care, Calorie, Younger age, business.industry, Parenteral hydration, Nutrition. Foods and food supply, Endocrinology, Diabetes and Metabolism, Parenteral nutrition, Advanced cancer, Artificially administered nutrition, Age groups, Internal medicine, medicine, Parenteral route, TX341-641, Enteral tube feeding, Prospective cohort study, business, Artificially administered hydration
Abstract

Summary: Background & Aims: The prevalence of artificially administered nutrition and hydration (AANH) in different age groups among patients with advanced cancer remains unknown. The present study investigated the current utilization of AANH according to age groups in palliative care units. Methods: This was a secondary analysis of a prospective cohort study. We obtained information on primary nutritional administration routes during the first week of admission and data on the averaged calorie sufficiency rate or total calorie intake on the 7th day of admission. Patients were divided into five age groups (18–39, 40–59, 60–74, 75–89, and 90- years). Among patients receiving AANH, the proportions of higher-calorie AANH were compared between the five age groups. Results: A total of 1453 patients were included. The proportion of patients categorized as receiving nutrition and hydration via the parenteral route was the highest in the 18–39 and 40–59 groups (52.4 and 41.1%, respectively). Among patients receiving AANH (n = 534), the proportions of patients categorized into the

Published
2021

2. How Successful Is Parenteral Oxycodone for Relieving Terminal Cancer Dyspnea Compared With Morphine? A Multicenter Prospective Observational Study

Author

Masanori Mori, Takashi Kawaguchi, Kengo Imai, Naosuke Yokomichi, Takashi Yamaguchi, Kozue Suzuki, Ryo Matsunuma, Hiroaki Watanabe, Isseki Maeda, Yuko Uehara, Tatsuya Morita, Satoshi Inoue, Hiroaki Tsukuura, Toshihiro Yamauchi, Akemi Shirado Naito, Yu Uneno, Akira Yoshioka, Shuji Hiramoto, Ayako Kikuchi, Tetsuo Hori, Yosuke Matsuda, Hiroyuki Kohara, Hiromi Fanaki, Keiko Tanaka, Tina Kamei, Yukari Azuma, Koji Amano, Teruaki Uno, Jiro Miyamoto, Hirofumi Katayama, Hideyuki Kashiwagi, Eri Matsumoto, Kiyofumi Oya, Takeya Yamaguchi, Tomonao Okamura, Hoshu Hashimoto, Shunsuke Kosugi, Nao Ikuta, Yaichiro Matsumoto, Takashi Ohmori, Takehiro Nakai, Takashi Ikee, Yuto Unoki, Kazuki Kitade, Shu Koito, Nanao Ishibashi, Masaya Ehara, Kosuke Kuwahara, Shohei Ueno, Shunsuke Nakashima, Yuta Ishiyama, Akihiro Sakashita, Hana Takatsu, Satoko Ito, Toru Terabayashi, Jun Nakagawa, Tetsuya Yamagiwa, Akira Inoue, Takuhiro Yamaguchi, Mitsunori Miyashita, Saran Yoshida, Yusuke Hiratsuka, Keita Tagami, Takuya Odagiri, Tetsuya Ito, Masayuki Ikenaga, Keiji Shimizu, Akira Hayakawa, Rena Kamura, Takeru Okoshi, Tomohiro Nishi, Kazuhiro Kosugi, Yasuhiro Shibata, Takayuki Hisanaga, Takahiro Higashibata, Ritsuko Yabuki, Shingo Hagiwara, Miho Shimokawa, Satoshi Miyake, Junko Nozato, Hiroto Ishiki, Tetsuji Iriyama, Keisuke Kaneishi, Mika Baba, Tomofumi Miura, Yoshihisa Matsumoto, Ayumi Okizaki, Yuki Sumazaki Watanabe, Yuko uehara, Eriko Satomi, Kaoru Nishijima, Junichi Shimoinaba, Ryoichi Nakahori, Takeshi Hirohashi, Jun Hamano, Natsuki Kawashima, Megumi Uchida, Ko Sato, Yoichi Matsuda, Yutaka Hatano, Satoru Tsuneto, Sayaka Maeda, Yoshiyuki Kizawa, and Hiroyuki Otani

Subjects
Lung Neoplasms, Palliative care, Subgroup analysis, Context (language use), law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, 030212 general & internal medicine, Lung cancer, General Nursing, Aged, Morphine, business.industry, Cancer, medicine.disease, respiratory tract diseases, Analgesics, Opioid, Dyspnea, Anesthesiology and Pain Medicine, 030220 oncology & carcinogenesis, Anesthesia, Neurology (clinical), business, Oxycodone, medicine.drug
Abstract

Parenteral morphine is widely used for dyspnea of imminently dying cancer patients (terminal dyspnea). However, the efficacy of other opioids such as oxycodone remains largely unknown.To explore the efficacy of parenteral oxycodone vs. morphine by continuous infusion over 24 hours in cancer patients with terminal dyspnea.This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were advanced cancer patients admitted to palliative care units, Eastern Cooperative Oncology Group performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS) for which oxycodone or morphine was initiated by continuous infusion. We measured dyspnea IPOS scores over 24 hours.We analyzed 164 patients who received oxycodone (n = 26) and morphine (n = 138) for dyspnea (median survival = 5 days). The mean age was 70 years, 58 patients (35%) had lung cancer, and 97 (59%) had lung metastases. Complete case analysis revealed that mean dyspnea IPOS scores decreased from 3.0 (standard deviation = 0.7) to 1.5 (0.7) in the oxycodone group (difference in means = 1.5; P 0.001), and from 2.9 (0.7) to 1.6 (1.0) in the morphine group (difference in means = 1.3; P 0.001). No significant between-group differences existed in the IPOS scores at 24 hours (P = 0.753). Adverse events were seen in no and 5 patients in the oxycodone and morphine groups, respectively.Parenteral oxycodone may be equally effective and safe as morphine in the treatment of terminal dyspnea in cancer patients. Future randomized controlled trials should confirm the efficacy and safety of opioids other than morphine for terminal dyspnea.

Published
2021
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3. Effects of enteral nutrition and parenteral nutrition on survival in patients with advanced cancer cachexia: Analysis of a multicenter prospective cohort study

Author

Koji Amano, Isseki Maeda, Hiroto Ishiki, Tomofumi Miura, Yutaka Hatano, Hiroaki Tsukuura, Tomohiko Taniyama, Yoshihisa Matsumoto, Yosuke Matsuda, Hiroyuki Kohara, Tatsuya Morita, Masanori Mori, Satoshi Inoue, Naosuke Yokomichi, Kengo Imai, Toshihiro Yamauchi, Akemi Shirado Naito, Yu Uneno, Akira Yoshioka, Shuji Hiramoto, Ayako Kikuchi, Tetsuo Hori, Hiromi Funaki, Keiko Tanaka, Kozue Suzuki, Tina Kamei, Yukari Azuma, Teruaki Uno, Jiro Miyamoto, Hirofumi Katayama, Hideyuki Kashiwagi, Eri Matsumoto, Kiyofumi Oya, Takeya Yamaguchi, Tomonao Okamura, Hoshu Hashimoto, Shunsuke Kosugi, Nao Ikuta, Yaichiro Matsumoto, Takashi Ohmori, Takehiro Nakai, Takashi Ikee, Yuto Unoki, Kazuki Kitade, Shu Koito, Nanao Ishibashi, Masaya Ehara, Kosuke Kuwahara, Shohei Ueno, Shunsuke Nakashima, Yuta Ishiyama, Akihiro Sakashita, Ryo Matsunuma, Hana Takatsu, Takashi Yamaguchi, Satoko Ito, Toru Terabayashi, Jun Nakagawa, Tetsuya Yamagiwa, Akira Inoue, Takuhiro Yamaguchi, Mitsunori Miyashita, Saran Yoshida, Yusuke Hiratsuka, Keita Tagami, Hiroaki Watanabe, Takuya Odagiri, Tetsuya Ito, Masayuki Ikenaga, Keiji Shimizu, Akira Hayakawa, Rena Kamura, Takeru Okoshi, Tomohiro Nishi, Kazuhiro Kosugi, Yasuhiro Shibata, Takayuki Hisanaga, Takahiro Higashibata, Ritsuko Yabuki, Shingo Hagiwara, Miho Shimokawa, Satoshi Miyake, Junko Nozato, Tetsuji Iriyama, Keisuke Kaneishi, Mika Baba, Ayumi Okizaki, Yuki Sumazaki Watanabe, Yuko Uehara, Eriko Satomi, Kaoru Nishijima, Junichi Shimoinaba, Ryoichi Nakahori, Takeshi Hirohashi, Jun Hamano, Natsuki Kawashima, Takashi Kawaguchi, Megumi Uchida, Ko Sato, Yoichi Matsuda, Satoru Tsuneto, Sayaka Maeda, Yoshiyuki Kizawa, and Hiroyuki Otani

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Parenteral Nutrition, Palliative care, Calorie, Cachexia, Nutritional Status, 030209 endocrinology & metabolism, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, Internal medicine, Neoplasms, medicine, Humans, In patient, Prospective Studies, Prospective cohort study, Enteral Tube Feeding, Aged, Proportional Hazards Models, Aged, 80 and over, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Palliative Care, Middle Aged, medicine.disease, Survival Rate, Parenteral nutrition, Treatment Outcome, Female, business, Energy Intake, Cohort study
Abstract

The benefits of artificial nutrition and hydration in patients with advanced cancer remain unknown. Therefore, we conducted a prospective study to evaluate effects of enteral nutrition (EN) and parenteral nutrition and hydration (PNH) on survival in palliative care units.This study involved a secondary analysis of a multicenter cohort study. Data of primary nutritional administration routes during the first week after admission (oral intake, enteral tube feeding, parenteral nutrition, parenteral hydration, poor oral intake) were obtained. Data of averaged calorie sufficiency rate/total calorie intake [high (75% ≤ or 750 kcal/day ≤), moderate (50-75% or 500-750 kcal/day), low (25-50% or 250-500 kcal/day), very low (25% or250 kcal/day)] were also obtained. After investigating the implementation of artificial nutrition and hydration, participants were divided into three groups according to the nutritional administration route and calorie sufficiency rate/total calorie intake: EN, PNH, and control. We conducted time-to-event analyses using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox regression analyses.Patients were divided into the EN group (n = 730), PNH group (n = 190), and control group (n = 533). Differences in survival rates among the three groups were significant (Log-rank P 0.001). Median survival times were 43.0 (95% CI 40-46), 33.0 (95% CI 29-37), and 15.0 (95% CI 14-16) days, respectively (P 0.001). In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox's proportional hazard model in the EN group and PNH groups (HR 0.43 [95% CI 0.37-0.49], P 0.001; and HR 0.52 [95% CI 0.44-0.62], P 0.001, respectively) than in the control group.This study indicated the clinical benefits of EN and PNH for patients with advanced cancer. Nevertheless, managing symptoms to improve oral intake is essential before initiation of PNH, because EN was superior to PNH.

Published
2020

4. Drip and ship method of IV-tPA for acute ischemic stroke patients in a depopulated area using a telemedicine system for emergency medicine (k-support)

Author

Nao Ikuta, Saki Nagase, Ryo Tabata, Fumiaki Obata, Kenji Tani, Keiko Mori, Hiroyasu Bando, and Teruyoshi Kageji

Subjects
Telemedicine, medicine.medical_specialty, business.industry, Emergency medicine, medicine, Medical emergency, business, medicine.disease, Acute ischemic stroke, Earth-Surface Processes
Published
2015
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