Eating-related distress in advanced cancer patients with cachexia and family members: a survey in palliative and supportive care settings.

PURPOSE: Few studies have investigated nutrition impact symptoms and eating-related distress among advanced cancer patients and their families. This is a questionnaire survey to examine the severity of nutrition impact symptoms and the prevalence of eating-related distress among them in palliative and supportive care settings. METHODS: Questionnaires for patients and their families were preliminarily developed. We selected 16 common symptoms of advanced cancer, i.e., 9 symptoms of the ESAS-r and 7 of the PG-SGA. Each questionnaire concerning eating-related distress consisted of 12 items. RESULTS: A total of 140 out of 147 patients responded (95.2%). They were classified into two groups: (1) non-cachexia/pre-cachexia (n = 57) and (2) cachexia/refractory cachexia (n = 83). The top 3 out of 16 symptoms in all patients were feeling of well-being, lack of appetite, and tiredness. Significant differences were observed in 8 symptoms between the two groups: tiredness (p = 0.007), drowsiness (p = 0.007), lack of appetite (p < 0.001), early satiety (p = 0.001), diarrhea (p = 0.025), abnormal taste (p = 0.02), difficulty swallowing (p = 0.002), and feeling of well-being (p = 0.003). Regarding eating-related distress in patients, significant differences were observed in all items, except for 2, between the two groups. Concerning eating-related distress in families, significant differences were observed in all items between the two groups. CONCLUSION: Advanced cancer patients with cachexia have more severe nutrition impact symptoms than those without cachexia, and patients with cachexia and their families have greater eating-related distress than those without cachexia.

Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings.

PURPOSE: Few studies have investigated the need for nutritional support in advanced cancer patients in palliative care settings. Therefore, we conducted a questionnaire to examine the relationship between the perception of need for nutritional support and cancer cachexia and the prevalence of specific needs, perceptions, and beliefs in nutritional support. METHODS: We conducted a questionnaire in palliative care settings. Patients were classified into two groups: (1) non-cachexia/pre-cachexia and (2) cachexia/refractory cachexia. RESULTS: A total of 117 out of 121 patients responded (96.7%). A significant difference was observed in the need for nutritional support between the groups: non-cachexia/pre-cachexia (32.7%) and cachexia/refractory cachexia (53.6%) (p = 0.031). The specific needs of patients requiring nutritional support were nutritional counseling (93.8%), ideas to improve food intake (87.5%), oral nutritional supplements (83.0%), parenteral nutrition and hydration (77.1%), and tube feeding (22.9%). The top perceptions regarding the best time to receive nutritional support and the best medical staff to provide nutritional support were "when anorexia, weight loss, and muscle weakness become apparent" (48.6%) and "nutritional support team" (67.3%), respectively. The top three beliefs of nutritional treatments were "I do not wish to receive tube feeding" (78.6%), "parenteral nutrition and hydration are essential" (60.7%), and "parenteral hydration is essential" (59.6%). CONCLUSIONS: Patients with cancer cachexia expressed a greater need for nutritional support. They wished to receive nutritional support from medical staff when they become unable to take sufficient nourishment orally and the negative impact of cachexia becomes apparent. Most patients wished to receive parenteral nutrition and hydration.

Need for nutritional support, eating-related distress and experience of terminally ill patients with cancer: a survey in an inpatient hospice.

OBJECTIVES: Cancer cachexia creates a large burden for terminally ill patients with cancer. The main causes are a lack of knowledge of cancer cachexia and unsuccessful attempts to increase body weight. The role of nutritional support has not been clarified, and patients' eating-related distress is poorly understood. There has been no study investigating into needs for nutritional support in an inpatient hospice. The primary aim of this study was to explore needs for nutritional support, eating-related distress and patients' experiences. METHODS: A survey was conducted involving 60 patients with advanced cancer in an inpatient hospice. We first asked about need for nutrition therapy in the inpatient hospice. We then asked whether patients had unmet needs for four items. The last question was composed of 19 items concerning patients' experience of eating-related distress. RESULTS: Thirty-seven patients responded (62%). Most of the patients, 28 of 37 (76%), had general unmet needs for nutrition therapy for cancer cachexia, and more than half needed specific support, such as 'attention' and 'explanation'. The top 5 of the 19 items were mainly about daily diet, nutrition and losing weight. Of these, the top four belonged to the group of coping strategies and the fifth to the group of mechanisms originating from patients themselves. CONCLUSIONS: A number of terminally ill patients with cancer admitted to an inpatient hospice had need for nutritional support and experienced high levels of eating-related distress.

Pharmacokinetics of Carboplatin in a One-Year-Old Anuric Boy Undergoing Hemodialysis and a Review of the Literature.

There have been few reports of carboplatin-based chemotherapy for anuric infants. As we had a chance to treat a one-year-old anuric hepatoblastoma patient with carboplatin, we performed a pharmacokinetic analysis and examined the optimal treatment strategy. A one-year-old anuric boy under peritoneal dialysis was diagnosed with hepatoblastoma. Surgical resection was performed, and administration of carboplatin was scheduled postoperatively aiming at 5 mg·min/mL of the area under the curve from the time of dosing to the time of the last observation (AUC(0-t)). We set the initial dose at 50 mg, higher than that calculated by the Calvert formula (34 mg); the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h; and the hemodialysis duration at 24 h. The actual AUC0-t was 3.05 mg·min/mL because the elimination half-lives before and during hemodialysis were shorter than expected. The AUC(0-t) after the second dose (100 mg) and the third dose (80 mg) were 7.00 and 4.68 mg·min/mL, respectively. The Calvert formula is not suitable for hemodialysis patients because removal of platinum by hemodialysis is not taken into account. It appears that extrarenal clearance in anuric infants is different from that in adults. We obtained an optimal AUC(0-t) using a dose of 80 mg (200 mg/m(2)), setting the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h, and performing 8-h hemodialysis. Further accumulation of the pharmacokinetic data of carboplatin is necessary for anuric children.

Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life.

BACKGROUND: Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. OBJECTIVE: This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. DESIGN: A retrospective cohort study in a cancer-designated hospital in Japan. SETTING/SUBJECTS: This study examined 266 consecutive cancer decedents. Inclusion criteria were adults and patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria. MEASUREMENTS: We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle and colleagues. RESULTS: Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% versus 47%, adjusted p<0.001). While each of six indicators of aggressiveness of EOL care did not differ significantly, the composite score was significantly lower in the early referral group (1.91±0.59 versus 2.14±0.78, adjusted p<0.001). CONCLUSIONS: Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.

Successful treatment of Kaposiform hemangioendothelioma with everolimus.

There is currently no consensus on the second-line management of Kaposiform hemangioendothelioma (KHE) that was resistant to prednisolone and vincristine. We described an eight-year-old male with KHE in the right femur that was resistant to prednisolone, vincristine and propranolol. Everolimus, an inhibitor of mammalian target of rapamycin (mTOR) at the dosage of 0.1 mg/kg/day, successfully decreased the tumor size and controlled the symptoms. Everolimus should be further studied as an alternative agent to sirolimus in the management of KHE.