The process of reaching psychological adjustment among adult women diagnosed with metastatic breast cancer and receiving cancer pharmacotherapy.

Objective: This study clarified the process by which adult women diagnosed with metastatic breast cancer (MBC) and undergoing cancer pharmacotherapy reach psychological adjustment. Methods: A semistructured interview was conducted with adult women who had received their MBC diagnosis. The data collected were analyzed using Kinoshita's modified grounded theory approach. Results: A total of 21 women with an average age of 50 years participated in the study. Seven categories and 21 concepts were generated through the analysis. Upon being diagnosed with MBC by a doctor, the participants felt the "threat of death" and "conflict with painful cancer pharmacotherapy." Thereafter, they received "encouragement from strong supporters," consolidated their "resolve to save their life," and began cancer pharmacotherapy. During the therapy, they made "efforts to internalize MBC" to overcome the distress arising from the "struggle to internalize MBC," and this led to the "expansion of self-awareness." Conclusions: Despite finding themselves in harsh circumstances, the participants remained focused on the big picture and realized that cancer had changed their values and outlook on life, leading to psychological growth. It is important for nurses to provide systematic and continuous support from the time of MBC diagnosis.

[Factors Affecting Adherence to Adjuvant Endocrine Therapy in Japanese Patients with Breast Cancer-An Observational Study].

The purpose of this study was to investigate adherence to adjuvant endocrine therapy (ET) and the factors affecting demotivation and motivation to continue adjuvant ET. In patients with hormone receptor-positive breast cancer in Japan, an online survey was conducted from June to July 2021 to investigate the treatment effects, side effects, concerns about side effects(for demotivation only), convenience of hospital visits, treatment duration, concerns about recurrence/progression, treatment cost, support from healthcare professionals, and support from family, the patient association, and peers(for motivation only). According to the responses from 263 patients, the most common factor affecting demotivation to continue adjuvant ET was the burden of side effects, and the most common factor affecting motivation to continue adjuvant ET was concerns about recurrence/progression. Continuous relief of the burden of side effects from the early stage of treatment, and mental support for concerns about recurrence/progression, as well as explaining and promoting the risks and benefits of continuing treatment, are considered to lead to motivation to continue adjuvant ET(Fig. 1: Summary of this survey).

Bmi-1 Immunohistochemical Expression in Endometrial Carcinoma is Correlated with Prognostic Activity.

Background and objectives: B-lymphoma Mo-MLV insertion region 1 (Bmi-1) is a stem cell factor that is overexpressed in various human cancer tissues. It has been implicated in cancer cell proliferation, cell invasion, distant metastasis, and chemosensitivity, and is associated with patient survival. Several reports have also identified Bmi-1 protein overexpression in endometrial carcinoma; however, the relationship between Bmi-1 expression and its significance as a clinicopathological parameter is still insufficiently understood. Accordingly, the present study aimed to clarify whether immunohistochemical staining for Bmi-1 in human endometrial carcinoma and normal endometrial tissues can be used as a prognostic and cell proliferation marker. Materials and Methods: Bmi-1 expression was assessed in endometrioid carcinoma (grade 1-3) and normal endometrial tissues (in the proliferative and secretory phases) by immunohistochemistry; protein expression was evaluated using the nuclear labeling index (%) in the hot spot. Furthermore, we examined other independent prognostic and proliferation markers, including the protein levels of Ki-67, p53, and cyclin A utilizing semi-serial sections of endometrial carcinoma tissues. Results: The expression of the Bmi-1 protein was significantly higher in all grades of endometrial carcinoma than in the secretory phase of normal tissues. Moreover, Bmi-1 levels tended to be higher in G2 and G3 tissues than in G1 tissue, without reaching significance. Bmi-1 expression showed no notable differences among International Federation of Gynecology and Obstetrics (FIGO) stages in endometrial carcinoma. Furthermore, we observed a significant positive relationship between Bmi-1 and Ki-67, cyclin A, or p53 by Spearman's rank correlation test, implying that high Bmi-1 expression can be an independent prognostic marker in endometrial carcinoma. Conclusions: Our study suggests that Bmi-1 levels in endometrial carcinoma tissues may be useful as a reliable proliferation and prognostic biomarker. Recently, the promise of anti-Bmi-1 strategies for the treatment of endometrial carcinoma has been detected. Our results provide fundamental data regarding this anti-Bmi-1 strategy.

[Clinical Value of "iEat®" in Terminal Cancer Patients Who Have Difficulty with Oral Intake of a Solid Diet].

The usefulness of "iEatR" was explored in a study of 13 terminal cancer patients who had difficulty ingesting a solid diet, but could ingest a liquid diet. The patients were given a questionnaire on the flavor, appearance, and ease of consumption after sampling 2 kinds of "iEatR". Patients wishing to continue consuming this diet were able to purchase "iEatR" at their own expense and were then surveyed regarding their ongoing consumption of "iEatR". The types of cancers were esophageal in 3 patients, gastric in 7, and pancreatic in 3. In the questionnaire, 10 of the 13 patients rated the flavor as good and 12 rated the appearance and ease of eating as good. Eleven of the 13 patients purchased "iEatR", and 61.5% of patients were still consuming "iEatR" at least 2 times per week 2 weeks after the sampling. No change in the Common Terminology Criteria for Adverse Events grade was seen in any of the patients."iEatR", which emphasizes appearance and taste, is associated with improved satisfaction in terminal cancer patients who have difficulty ingesting solids, suggesting it is useful as a diet for these patients.

[Efficacy of AboundTM for hand-foot syndrome caused by capecitabine].

Hand-foot syndrome( HFS) has been reported to be the most common adverse effect of capecitabine, with an incidence of more than 50%. AboundTM, containing ß-hydroxy-ß-methyl butyric acid( HMB), L-glutamine, and L-arginine is effective in the treatment of decubitus ulcers and in wound healing; however, whether AboundTM is efficacious for HFS caused by capecitabine is not clear. This study aimed at evaluating the effectiveness of AboundTM in the recovery from HFS caused by capecitabine. Capecitabine administration was discontinued in 6 patients with more than grade 2 HFS, and AboundTM was administered. The time to recovery was examined. The median time to recovery to less than grade 1 HFS was 10 days( range, 4-14 days). The grade of HFS decreased following the administration of AboundTM. The findings of this study suggest that AboundTM is effective against HFS caused by capecitabine.

[Evaluation of outpatient clinical pathway, including the supportive therapy of S-1+cisplatin combination therapy for gastric cancer].

S-1+cisplatin (CDDP) combination therapy is a standard regimen for advanced gastric cancer and is usually administered within the hospital environment. Recently, ambulatory chemotherapy has been applied to treat various cancers. For the realization of outpatient treatment, it is necessary to strengthen supportive therapy. We developed a comprehensive and supportive care clinical pathway. The use of this pathway in combination with the expertise of pharmacists has resulted in enhanced supportive therapy, reduced side effects, and increased treatment intensity.

[Assessment of nausea and vomiting during FEC regimen for breast cancer after the novel antiemetic agent - introduction using MASCC antiemesis tool].

Chemotherapy-induced nausea and vomiting(CINV)is one of the side effects causing significant psychological and physical suffering in patients receiving chemotherapy. Because CINV often impairs patients' quality of life and leads to discontinuation of treatments, antiemetic therapy has been considered important. The MASCC Antiemesis Tool(MAT)was proposed for the assessment of acute and delayed nausea and vomiting after, we evaluated the actual situation of nausea and vomiting for Japanese patients. In a previous investigation, even conventional antiemesis therapy was a highly effective treatment during the acute phase, but the control of nausea and vomiting during the delayed phase proved difficult. Recently, a new5 -HT3 receptor blocker(palonosetron)and an NK1 receptor blocker(aprepitant) were introduced, and an effective treatment of nausea and vomiting for the delayed phase is non expected. In this examination, we evaluated the usefulness of the new antiemetic drugs(palonosetron and aprepitant)in 12 prospective patients with breast cancer(40-69 years old, median age 53 years old)for whom FEC therapy was given as an ambulant treatment using MAT. No vomiting occurred in the acute and delayed phase. Nausea during the acute phase was controlled, and was mild during the delayed phase, also. It was confirmed that the onset of acute and delayed nausea and vomiting were relieved by the newantiemetic agents compared with the previous MAT evaluation.