Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors

To assess the impact of cancer (IOC) on subsequent quality of life (QOL), 718 long‐term haematological cancer survivors completed validated psychosocial, functional and QOL scales, including IOC. Fifteen percent reported significant psychological distress, 18% high levels of fatigue and 10% moderate to severe functional impairment. These groups of participants also showed poorer QOL. There were no significant differences in psychological distress (P = 0·76), fatigue (P = 0·23) or functional impairment (P = 0·74) across different cancer subtypes. Two separate hierarchical regression analyses examined the combined association of disease‐type, psychosocial and other factors on negative and positive IOC scores respectively. Higher negative IOC scores were significantly associated (P ≤ 0·001) with medical comorbidity, psychological distress, lower social support, high fatigue levels and functional impairment. Paediatric patients (diagnosed at <17 years) had significantly higher negative IOC scores than adult patients (P = 0·001); greater years since diagnosis was significantly (P < 0·001) associated with less negative IOC. Higher positive IOC was associated with acute leukaemia (P = 0·01); lower positive IOC with paediatric patients (P < 0·001), white ethnicity (P < 0·001), higher education (P = 0·003), no partner (P = 0·01) and lower social support (P = 0·01). Screening for medical comorbidity, psychological distress and fatigue identifies those needing most support and should allow earlier interventions to address negative and positive IOC to improve the well‐being of cancer survivors.     

Japan Clinical Oncology Group (JCOG) prognostic index and characterization of long‐term survivors of aggressive adult T‐cell leukaemia‐lymphoma (JCOG0902A)

This study evaluated the clinical features of 276 patients with aggressive adult T‐cell leukaemia‐lymphoma (ATL) in 3 Japan Clinical Oncology Group (JCOG) trials. We assessed the long‐term survivors who survived >5 years and constructed a prognostic index (PI), named the JCOG‐PI, based on covariates obtained by Cox regression analysis. The median survival time (MST) of the entire cohort was 11 months. In 37 patients who survived >5 years, no disease‐related deaths in 10 patients with lymphoma‐type were observed in contrast to the 10 ATL‐related deaths in other types. In multivariate analysis of 193 patients, the JCOG‐PI based on corrected calcium levels and performance status identified moderate and high risk groups with an MST of 14 and 8 months respectively (hazard ratio, 1·926). The JCOG‐PI was reproducible in an external validation. Patients with lymphoma‐type who survived >5 years might have been cured. The JCOG‐PI is valuable for identifying patients with extremely poor prognosis and will be useful for the design of future trials combining new drugs or investigational treatment strategies.     

Direct costs of acute respiratory infections in a pediatric long‐term care facility

Acute respiratory tract infections (ARI) are a major burden in pediatric long‐term care. We analyzed the financial impact of ARI in 2012–2013. Costs associated with ARI during the respiratory viral season were ten times greater than during the non‐respiratory viral season, $31 224 and $3242 per 1000 patient‐days, respectively (P < 0·001). ARI are burdensome for pediatric long‐term care facilities not only because of the associated morbidity and mortality, but also due to the great financial costs of prevention.     

In‐depth descriptive analysis of trends in prevalence of long‐term care in Japan

Background: Long‐term care (LTC) insurance was introduced in Japan in 2000. Herein, we describe the trends in demand for LTC, using age‐standardized and level‐specific rates of entitlement and utilization of LTC at national and prefectural levels. Methods: We analyzed LTC data from 2002–2005 to examine: (i) the influence of population aging, calculating crude and age‐standardized entitlement and utilization rates; (ii) the relation between baseline entitlement rate and increase in the rate over this 3‐year period; and (iii) differences in increases in entitlement rate between low and high care levels. Results: The entitlement and utilization rates increased even after adjustment for age; approximately two‐thirds of the increase was not due to population aging. Variations in the entitlement rates among prefectures did not decrease (coefficient of variance was 0.12 in 2002 and 0.11 in 2005), and there was no significant correlation between baseline entitlement rates and the later increases among prefectures (r = ?0.20, P = 0.19). The increase in entitlement rate was larger for low than for high care levels (31% vs 6%), and those for low and high care levels were weakly correlated. Conclusion: This study suggested that a large part of the increase in LTC demand could not be explained by population aging, and the increase did not result from equalization of LTC services across the country. In addition, it seems that the demands of low and high care levels depend on different factors. The increase in LTC demand should be monitored carefully to identify underlying factors and to ensure sustainability of the system.     

Prediction of long‐term clinical outcome in a diverse chronic hepatitis B population: Role of the PAGE‐B score

An abundance of noninvasive scores have been associated with fibrosis and hepatocellular carcinoma (HCC) development. We aimed to compare the prognostic ability of these scores in relation to liver histology in chronic hepatitis B (CHB) patients. Liver biopsies from treatment‐naïve CHB patients at one tertiary care centre were scored by a single hepato‐pathologist. Laboratory values at liver biopsy were used to calculate the PAGE‐B, REACH‐B, GAG‐HCC, CU‐HCC and FIB‐4 scores. Any clinical event was defined as HCC development, liver failure, transplantation and mortality. HCC and mortality data were obtained from national database registries. Of 557 patients, 40 developed a clinical event within a median follow‐up of 10.1 (IQR 5.7‐15.9) years. The PAGE‐B score predicted any clinical event (C‐statistic.86, 95% CI: 0.80‐0.92), HCC development (C‐statistic .91) and reduced transplant‐free survival (C‐statistic .83) with good accuracy, also when stratified by ethnicity, antiviral therapy after biopsy or advanced fibrosis. The C‐statistics (95% CI) of the REACH‐B, GAG‐HCC, CU‐HCC and FIB‐4 scores for any event were .70 (0.59‐0.81), .82 (0.75‐0.89), .73 (0.63‐0.84) and.79 (0.69‐0.89), respectively. The PAGE‐B event risk assessment improved modestly when combined with the Ishak fibrosis stage (C‐statistic .87, 95% CI: 0.82‐0.93). The PAGE‐B score showed the best performance in assessing the likelihood of developing a clinical event among a diverse CHB population over 15 years of follow‐up. Additional liver histological characteristics did not appear to provide a clinically significant improvement.     

Both conventional indices of cognitive function and frailty predict levels of care required in a long‐term care insurance program for memory clinic patients in Japan

Aim: To delineate relationships among cognitive function, frailty and level of care required in the Japanese long‐term care insurance program (LTCIP) in outpatient memory clinic patients. Methods: This was a cross‐sectional study carried out at an outpatient memory clinic. Participants were 201 cognitively impaired patients. Cognitive function was measured by the Mini‐Mental State Examination (MMSE). Frailty was measured by Timed Up & Go (TUG) and grip strength. Waist circumference, body mass index, living arrangement and level of care required in the LTCIP (rank 1 minor disability to rank 7 severe disability) were also assessed. Results: Mean age, MMSE score, TUG score and grip strength were 78.8 ± 6.9 years, 19.6 ± 6.1, 14.6 ± 6.7 s and 16.9 ± 7.5 kg, respectively. A total of 70 patients (34.8%) had not applied for the certification, at least in part because of their younger age and existence of family caregivers. LTCIP rank was correlated both with MMSE score (β: ?0.49, P = 0.001), grip strength (β: ?0.27, P = 0.005) and living alone (β: ?0.18, P = 0.03), but not with TUG score (β: 0.14, P = 0.105). Conclusion: In outpatients of a memory clinic, care ranks, which define the upper limit of monthly benefit in the Japanese LTCIP, were influenced by age, cognitive function, frailty and living arrangements. Understanding the relationship among these parameters would be useful in predicting the needs of cognitively impaired patients and important when comparing the possible services provided by long‐term care systems for them worldwide. Geriatr Gerontol Int 2012; ??: ??–?? .