The influence of family willingness to home palliative care

In the current state of medical treatment, cancer patients discharged from hospital to home have been increasing. For enforcement of home palliative care, we think that family willingness to care for the patient is very important. We examined how much the willingness of a family to care for the patient influences the enforcement of home palliative care and the factors that influence the willingness of care given by the family. When the family willingness to care for the patient was low, there were significantly lower patient deaths at home. Meanwhile, the length of home care was also significantly short. In fact, there was a tendency to influence the outcome of home palliative care by increasing the willingness to care for the patient by the family when the number of caregivers was high, additional medical treatment given to the patient and a good QOL at the time of discharge. Based on the STAS evaluation result, the willingness to care for the patient by the family was significantly higher when anxiety between the patient and his family is low, understanding of the state of the disease is good and communication between the patient and the family is good. We thought that the willingness to care for the patient provided by the family influences greatly in order to enforce home palliative care to be successful. We also thought that it is important to provide appropriate information to the patient and his family, and to resolve individual patients' problems as well.     

Progress of introduction of artificial respirator at home--the knowledge I have gained from a 19 year-old patient requiring a home respiratory management care and through the friendship with his family members

The patient developed right cerebellar hemorrhage at the age of 15 and spent four years at hospital. The patient and the family members had a strong wish to bring the patient back home and the patient was admitted to the hospital to undergo guidance about home medical care. The patient had paralysis of right upper and lower extremities and generalized strong ataxic motion and was under gastric feeding and had underwent tracheotomy to cope with hypoventilation, which required use of an artificial respirator at night hours. Since the patient was still as young as 19, we want to have the patient "go home" as they wanted. Fortunately, the mother who had to play key roles was still young and the parents worked at home. It didn't take long for them to master the techniques though they had various anxieties. It is considered important in the guidance on home medical care to what degrees the caregivers accept the condition of the patient and can imagine the long lasting care at home. We provided assistance while repeatedly interviewing with the patient and family members considering the significance to confirm their willingness and psychological condition. As a result, the patient was discharged from the hospital in two months. Now, two years have passed, and the patient is still cared at home and the possibility of the patient is sought for. The progress is reported here in this article.     

A case of unresectable pancreatic cancer showing tumor dormancy treated with gemcitabine

A 67-year-old woman visited our hospital with a chief complaint of epigastralgia. The patient was diagnosed as having unresectable pancreatic cancer because abdominal CT and angiography revealed a tumor that had invaded a common bile duct, portal vein and superior mesenteric vein. A palliative operation was performed because of obstructive jaundice. Peritoneal dissemination was observed and confirmed pathologically. The patient was treated with gemcitabine after the palliative operation. A gemcitabine 30 min i.v. infusion at a starting dose of 1,000 mg/m2 was administered once a week for 3 weeks with a 1-week rest. The patient experienced grade 2 leukocytopenia, so the dose of gemcitabine was reduced to continue the chemotherapy. The patient continued to undergo the palliative chemotherapy without severe adverse effects. As a result, the patient was in tumor dormancy for 15 months. It is important for the patient to induce an acceptable level of toxicity in clinical practice and to continue the chemotherapy.     

CD19及CD22嵌合抗原受体T细胞序贯治疗复发难治纵隔B淋巴母细胞淋巴瘤一例并文献复习

目的探讨CD19及CD22嵌合抗原受体T细胞(CAR-T)序贯治疗复发难治纵隔B淋巴母细胞淋巴瘤(B-LBL)的效果。方法报道华中科技大学同济医学院附属同济医院2017年3月收治的1例经CD19及CD22 CAR-T序贯治疗的复发难治纵隔B-LBL患者,分析CD19及CD22 CAR-T序贯治疗后1、3、6、12、18个月原发病缓解相关指标,并复习相关文献。结果该患者经过三线化疗后疾病复发进展,后行CD19及CD22CAR-T序贯治疗。在细胞免疫治疗过程中,患者出现1级细胞因子释放综合征,经积极治疗,病情稳定后出院。患者定期来院复查,动态追踪观察纵隔包块。行CAR-T治疗后患者纵隔包块明显缩小,病情持续缓解达18个月。结论 CD19及CD22 CAR-T序贯治疗为复发难治B-LBL提供了新的治疗手段。对于常规化疗效果欠佳的患者,应尽早积极行CAR-T治疗,从而提高缓解率,改善患者的远期预后。     

Home medical support for an elderly patient and his family

We provided a support for a 70s male patient diagnosed with chronic subdural hemorrhage and his family. This patient was supposed to move to another hospital for further medical treatments. However, we found some financial problems associated with this family. We then decided the patient should be treated best at home instead of the patient to be at another hospital. In doing so, we arranged a social worker with a background in home medical care for the patient. Meanwhile, the care manager and home visiting nurse instructed general homecare know-how to the family. Consequently, the patient was discharged from our hospital smoothly. In order to be successful in home medical support, a social worker should have a leading role with the following qualities: (1) Anticipate and assess the needs of daily livings for the patient and his family in addition to the home medical knowledge. (2) Provide necessary information for a decision making process on behalf of the patient and his family in regard to homecare medicine. (3) Be a homecare coordinator to the patient, his family, care manager and visiting nurse.     

SF测定对乳腺癌术后复发与转移监测意义的研究

 作者测定了112例乳腺癌术后患者的SF值，并对部分患者进行了动态观察，结果：无临床可见癌灶患者的SF值不高，有临床可见癌灶患者的SF值比正常对照组及无临床可见癌灶组都高，有内脏或骨转移患者SF值比单纯局部复发或浅表淋巴结转移者都高，在动态观察患者中，内脏或骨转移后SF值较转移前明显增高，未转移者的SF值自始至终变化不大，提示SF测定对乳腺癌术后的复发、转移监测有一定的参考价值。     

Combination Chemotherapy for a Senile Patient with Adenoid Cystic Carcinoma of the Esophagus: A Case Report

Adenoid cystic carcinoma of the esophagus with multiple livermetastases was found in a 77-year-old Japanese female in October,1991. Combination chemotherapy, including etoposide (VP-16)and tegafur (FT) allowed the patient to survive for approximatelya year after the onset of the initial symptoms. During her courseof treatment, the patient improved greatly with minimal toxicity,and declines in the elevated levels of GOT and LDH were alsonoted. Since no other therapy, such as surgery or radiation,was given to the patient, the response to chemotherapy as wellas the survival advantage for the patient have been evaluated.     

Silicone elastomer catheter for chronic vascular access

The Evanston and Glenbrook Hospitals' series of 157 consecutive silicone elastomer central venous catheter insertions is reviewed. The total experience was 12,721 patient days (34.85 patient years). The complication rate of insertion was 1.91%, but no patient required chest tube drainage. Seven catheters clotted and could not be salvaged. Seventeen catheters were removed for suspected bacterial infection. Peripheral blood culture was not predictive of catheter tip contamination, while culture of blood drawn through the catheter and insertion site cultures proved most useful. Five bona fide infections were documented for an infection rate of 3.18%. This corresponds to one infection per 2,544 patient days (6.97 patient years). The mean duration of service of the catheter was 81 days with a median of 36 days. The longest duration was 707 days. The silicone elastomer catheter provides safe, dependable venous access for most patients and may be inserted in an outpatient and therefore cost-effective setting.     

Chemotherapy for an esophageal cancer patient undergoing continuous ambulatory peritoneal dialysis for chronic renal failure and measurement of plasma concentration of the drug

We administered chemoradiotherapy consisting of 5-fluorouracil (5-FU) combined with cisplatin, radiation and sequential chemotherapy using nedaplatin for an esophageal cancer patient undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure. There are no reports in the literature of chemotherapy for a patient maintained on CAPD. The dosage of each drug was based on that for a patient undergoing hemodialysis, and the plasma concentration of each drug was examined. Chemotherapy consisted of 3-10 mg/body of cisplatin with 60-min infusion and 450 mg/body of 5-FU with continuous infusion over 5 days. There were no side effects and no increase in the concentration of either of the drugs. Subsequently, 50 mg/body of nedaplatin, which is half the dose for a patient with normal renal function, was administered. The area under the blood concentration time curve (AUC) of nedaplatin was 15.85 microg/ml, which was slightly low compared with that after infusion of 80 mg/m2 in patients with normal renal function. Grade 3 leukopenia and thrombocytopenia occurred. As a final result, a partial response was obtained, and the patient was able to eat solid food after treatment. Although chemotherapy consisting of low-doses of cisplatin and 5-FU and a half dose of nedaplatin was administered safely, further study is needed to determine the suitable regimens for a patient maintained on CAPD.     

Efficacy of vinorelbine and zoledronate combination therapy against postoperative recurrence of lung cancer

We report a case of a response to long-term treatment with vinorelbine and zoledronate in a patient with lymph node and multiple bone metastases after lung cancer surgery. CASE: The patient was a 70-year-old male initially examined by a local physician for an abnormal shadow that had been detected on a chest X-ray during a screening examination. CT revealed a mass shadow measuring 28 mm in diameter in the left S10, and because lung cancer was suspected, the patient was admitted to our hospital for the first time and examined. Lung cancer was diagnosed intraoperatively, and left lower lobectomy was performed. The pathological stage was III a, and postoperative adjuvant chemotherapy was performed, but recurrences in the form of lymph node and multiple bone metastases were detected. After diagnosis of the recurrence, the patient was treated with long-term vinorelbine (VNR)biweekly and zoledronate (ZOL) monthly, and a response was obtained. CONCLUSIONS: A patient with postoperative recurrence of lung cancer associated with multiple bone metastases responded to combination chemotherapy with VNR and ZOL. VNR was effective against postoperative recurrence in an elderly lung cancer patient with complications, and could be administered safely long-term. ZOL also had a favorable protective effect against skeletal-related events (SREs) in lung cancer, and the results suggested that it also had an antitumor effect in this patient.     

Two cases of leiomyosarcoma of the duodenum

Two cases of a leiomyosarcoma of the duodenum are reported. The first patient, a seventy-year-old woman, had experienced repeated instances of melena. She was diagnosed as having a leiomyosarcoma of the duodenum preoperatively, and was successfully given a pancreatoduodenectomy. The second patient, a fifty-one year-old woman, also had experienced instances of melena. Similarly, she was diagnosed an having leiomyosarcoma of the duodenum preoperatively, and was given a partial gastrectomy. A pathological examination showed little mitosis in either patient. The first patient is still alive three months after the operation, and the second patient also has been surviving for twelve years postoperatively.     

Duration of hospitalization as a measure of cost on Children's Cancer Group acute lymphoblastic leukemia studies.

PURPOSE: We used duration of hospitalization as a surrogate for cost and event-free survival as a measure of effectiveness to estimate the cost-effectiveness ratios of various treatment regimens on Children's Cancer Group trials for acute lymphoblastic leukemia. PATIENTS AND METHODS: The analyses included 4,986 children (2 to 21 years of age) with newly diagnosed acute lymphoblastic leukemia enrolled onto risk-adjusted protocols between 1988 and 1995. Analyses were based on a model of 100 patients. The marginal cost-effectiveness ratio (hospital days per additional patient surviving event-free) was the difference in total duration of hospitalization divided by the difference in number of event-free survivors at 5 years for two regimens. Relapse-adjusted marginal cost of frontline therapy was the difference in total duration of hospitalization for frontline therapy plus relapse therapy divided by the difference in number of event-free survivors at 5 years on the frontline therapy for two regimens. RESULTS: One or two delayed intensification (DI) phases, augmented therapy, and dexamethasone all improved outcome. Marginal cost-effectiveness of these regimens compared with the control regimens was 133 days per patient for DI, 117 days per patient for double DI, and 41 days per patient for augmented therapy. Dexamethasone resulted in 17 fewer days per patient. Relapse-adjusted marginal costs were 68 days per patient for DI and 52 days for double DI. Augmented therapy and dexamethasone-based therapy resulted in 16 and 82 fewer hospital days, respectively. The estimated cost-effectiveness for treating any first relapse was 250 days per patient. CONCLUSION: DI, double DI, augmented therapy, and dexamethasone-based therapy are cost-effective strategies compared with current treatment of first relapse.     

Treatment of metastatic chemodectoma.

Six patients were treated for metastatic chemodectoma at Memorial Sloan-Kettering Cancer Center from 1971 through 1988. Four patients' primary tumors arose in the cervical region, and two arose in the retroperitoneum. Four patients received a total of eight different chemotherapeutic regimens, including cisplatin, doxorubicin, cyclophosphamide, and dacarbazine. Metastatic sites treated included bone, liver, lung, and retroperitoneum. No patient had a response to chemotherapy. Four patients received a total of nine courses of radiation therapy for palliation of bone metastases. Pain relief was complete in eight patients and partial in one. One patient was irradiated for a mass in the left psoas muscle, with stabilization of disease for 6 months after treatment. One patient was irradiated for epidural compression at T6, with resolution of neurologic symptoms and 50% clearing of the spinal block on follow-up myelogram. Recurrence or progression of disease in a previously irradiated site occurred in one patient 2 years after treatment. One patient was lost to follow-up 3 months after radiation therapy for epidural compression. The other five patients died of widespread metastatic disease 6 months to 9 years after initial treatment for their metastatic disease.     

The roles of a visiting nurse for a terminal stage patient with chronic renal failure: a case study

A visiting nursing service was provided for an 87-year-old male patient with terminal stage of chronic renal failure. Although his primary doctor told us that the patient's prognosis is no good with general prostration, the patient was cared at home because his family strongly wanted him in a home care environment. The patient, who is having a right nephrostomy catheter and urethrovesical indwelling catheter and is in an unstable condition due to dehydration caused by an aggravation of renal failure, left the hospital in the end of August in 2005. Meanwhile, a family care giver was feeling uneasiness due to a lack of experience in giving medical treatment and to care for the patient. Therefore, a visiting nurse provided support to reduce the caregiver's anxiety and taught how to observe the patient's conditions, to give medical treatment and a method to care the patient at home. As a result, the patient's symptom was little improved to a lesser degree of stable condition. The family caregiver's anxiety was also reduced as well. The roles of a visiting nurse for a terminal stage patient are: (1) to urge the family care giver to obtain basic self reliant home care techniques, (2) to create a division of clear roles among the family members, (3) to execute an individualized life for the patient and family, (4) to try to establish a system to cooperate with a medical support group.     

The Effect of a Patient Navigator on Treatment Abandonment and Follow-up for High Grade Osteosarcoma Patients in the Philippine General Hospital

Introduction: Treatment abandonment for osteosarcoma is a significant problem in developing countries with rates as high as 70%. This study aimed to determine the effect of a patient navigator on treatment abandonment and patient follow-up of osteosarcoma patients at a tertiary referral center. Materials and Methods: A retrospective review of osteosarcoma patients was performed investigating 2 cohorts based on the start of the patient navigator. Group 1 (Pre-Patient Navigator, n=46) were treated from January 2016 to December 2017 while Group 2 (Post-Patient Navigator, n=29) were treated from January 2018 to June 2019. The primary outcome investigated was treatment abandonment defined as missing 4 or more consecutive weeks of treatment. Semi-structured interviews were conducted to investigate the effect of the patient navigator on the cohorts. Results: Treatment abandonment rates for the Pre-Patient Navigator group was significantly higher compared to those with a patient navigator (50% vs 6%, p=0.0001). Abandonment for the pre-navigator group occurred at a mean of 2.9 months (0 – 9 months, median 3 months). Fourteen of 23 patients who abandoned from Group 1 did not proceed to neoadjuvant chemotherapy while 3 patients abandoned after completing 1 cycle of neoadjuvant chemotherapy. In the patient navigator group, no patients abandoned prior to completing 3 cycles of chemotherapy. One patient abandoned after refusing a below knee amputation after 3 cycles of neoadjuvant chemotherapy and 1 patient did not complete further chemotherapy after having a hip disarticulation. Patient feedback on the patient navigator experience was favorable. Conclusions: Having a patient navigator from diagnosis throughout treatment reduced treatment abandonment rates in osteosarcoma patients and may serve as a model for other low to middle income countries.     

Relationship between epidemiologic and endocrinologic aspects of cervical cancer.

In search of etiologic relevancy of the steroid deviations in urine, we compared the reproductive activities of patients having cervical cancer with those of normal controls. A premenopausal patient experienced the birth of her first child significantly earlier than did the urban control of corresponding age, despite their similarity of age at menarche. However, when the same patient was compared with the premenopausal rural control, this differences was not found. The same parameter also failed to differentiate a postmenopausal patient from the corresponding control of urban origin. The premenopausal patient who was indistinguishable from the rural control by age at first delivery was distinguished from the rural control by reduced excretions of adrenal steroids including 11-deoxy-17 ketosteroids and some corticosteroid metabolites. The spectrum and the degree of deviation of urinary steroids for a patient coincided with the spectrum and the degree of age dependency of the urinary steroids for a normal woman during and after adolescence. These findings indicated that the inability of the reproductive parameter to discriminate a patient was associated with growth retardation in a population, and a maturation deficiency of the adrenal gland (arrest of adrenarche) was implicated in the genesis of cervical cancer.     

Effect of intraarterial noradrenaline-induced hypertensive chemotherapy of hepatic metastasis in gastric cancer

Four patients with hepatic metastasis of gastric cancer (one synchronous, three metachronous), received intraarterial noradrenaline-induced hypertensive chemotherapy. The outlet of the indwelling catheter was placed in the proper hepatic artery in two patients, in the thoracic aorta in one patient and in both places in one patient. When the systolic blood pressure rose 50 percent above the level in the untreated state, mitomycin C via the catheter was administered for 10 minutes. Partial remission was found in 2 patients, NC in one patient and PD in another. One patient showing PR died of a relapse of hepatic metastasis 8 months after treatment. Another patient with PD died of multiple bone metastases after 12 months. The two other patients are alive 19 months after treatment. Intraarterial noradrenaline-induced hypertensive chemotherapy is one of the useful treatments of choice for hepatic metastasis of gastric cancer.     

Prognostic-significance of chromosome 5q and 17p allelic deletion in colorectal adenocarcinomas

Patient survival was analysed for 75 patients after surgery for primary colorectal adenocarcinoma with regards to allelic loss of chromosome 17p and chromosome 5q. Allelic loss of chromosome 17p occurred in 69% of patients and was not significantly associated with a poorer patient prognosis as assessed by log rank analysis of Kaplan-Meier survival plots (p = 0.161). Allelic loss of chromosome 5q occurred in 32% of patients and was significantly associated with a poorer patient prognosis as assessed by log rank analysis of Kaplan-Meier survival plots (p = 0.014). Analysis of the two variables by Cox regression analysis indicated that allelic loss of chromosome 5q was an independent variable for patient prognosis. Entry of Dukes' stage into the model resulted in a final model with Dukes' stage and allelic loss of chromosome 5q as independent significant variables in assessing patient survival. These results show that allelic loss of chromosome 5q, but not chromosome 17p provides additional prognostic information for assessing patient survival, over and above Dukes' stage.     

Malignant fibrous histiocytoma of the scrotal wall--a case report

The case involves a 64-year-old male who was found to have a gradually enlarging tumor which was responsible for a slight tenderness in his scrotum for a month. Tumor excision was performed, and the tumor size was found to be 3 X 2 X 2 cm. A histologic examination of this tumor revealed a malignant fibrous histiocytoma of the scrotal wall. The patient received UFT chemotherapy. Five months after the excision, the patient was rehospitalized with a local recurrence in the scrotum. After a second operation, the patient was treated with radiotherapy.