Résumé
Objective@#This study aimed to assess gynecologic oncologists (GOs)’ perceptions and attitudes toward cancer survivorship to help improve survivor care. @*Methods@#We conducted a web-based questionnaire survey about survivorship issues for the GOs belonging to the Japan Gynecologic Oncology Group. We analyzed the proactiveness of the participants toward addressing 25 survivor issues. In addition, the practice patterns and barriers to care for survivors’ long-term health issues, such as second primary cancer (SPC) and lifestyle-related diseases (LSRD), and return-to-work (RTW) support were assessed. @*Results@#We received 313 responses. The respondents had a mean of 22 years of physician experience. The ratio of men to women was approximately 7:3, and 84.7% worked at facilities for multidisciplinary cancer treatment. The respondents’ proactiveness for addressing psychosocial problems was significantly lower than physical and gynecological issues (p<0.01 by χ2 test). However, most GOs tried to contribute to such issues according to patients’ demands. Women GOs were more proactively involved in some survivorship issues than the men (p<0.05 by logistic regression analysis). The rates of the respondents who proactively discussed SPC, LSRD, and RTW were unexpectedly high (60.7%, 36.1%, and 52.4%, respectively). However, the GOs only provided verbal support for these issues in many cases. @*Conclusion@#The Japanese GOs were enthusiastic about survivorship care. However, their tendency to deal with survivors’ problems through their own knowledge and judgments raises concerns about the quality of care. Therefore, creating survivorship care guidelines and enhancing multidisciplinary collaboration should be prioritized.
Résumé
In order to evaluate the clinical usefulness of Sairei-to in the treatment of toxemia of pregnancy and to study its influence on the waveform of the umbilical arterial blood flow, a standard curve of the pulsatility index (PI) was constructed for 90 patients in their 19th through 41st weeks of normal pregnancy. A dose of 9.0g/day of Sairei-to was then given to 13 patients with edema (mild toxemia) and 3 patients with severe toxemia. These cases were observed for clinical improvement and changes in the PI. The results were as follows: 1) of the 13 patients with mild toxemia, edema improved in 12 cases (92%), along with a decrease in the PI of all of these cases as a result of administration of this Kampo formula, 2) Regarding the 3 patients with severe toxemia, the clinical usefulness of Sairei-to was not clear. In 2 of these cases, arrest of the endodiastolic velocity was observed 6 to 7 days after the start of administration, making it necessary to perform emergency cesarean sections. These findings suggest that in mild toxemia of pregnancy, due to the hydragogue effect of Sairei-to, alleviation of edema and improvement of the insufficiency of placental blood flow, demonstrated by a decrease in PI, could be expected. In severe toxemia, on the other hand, irreversible change had already occurred in the placenta, and consequently, no positive improvement in the insufficiency of placental blood flow could be expected with the administration of Sairei-to. Thus, administration served only to supplement other treatment methods in this group.