[A Survey of Health Food Use and Patient Satisfaction among Patients Undergoing Cancer Pharmacotherapy].

This study aimed to clarify the situation of use of health foods by patients and the level of satisfaction of patients in order to make use of information on cases where patients undergoing cancer medication therapy use health foods. Between May 7, 2018 and June 29, 2018, we conducted a questionnaire survey of patients with progressive cancer who were undergoing cancer chemotherapy at Ogaki Municipal Hospital. In addition, we conducted a multivariate analysis of patients who were using health foods and those who were not. The questionnaire items included the objectives of use, product effectiveness and satisfaction, and QOL. The rate of health food use was 81/281 (29.5%). The primary objectives of use were, "to maintain health" (29.8%) and "to alleviate symptoms" (24.0%). The primary sources of information about health foods were "a friend" (50.6%) and "TV" (13.5%). The satisfaction level was 0-3 points in 8.3% of patients, 4-6 points in 38.1% of patients, and 7-10 points in 53.6% of patients. For "stage of illness (recurrence)," the odds ratio was 1.810 (95% CI, 1.040-3.150; p=0.035), and for "QOL value," the odds ratio was 2.210 (95% CI, 1.220-4.020; p=0.009), indicating that these factors had a significant influence on health food use. Health foods tended to be used in patients who had recurring cancer with low QOL and various symptoms, and friends and other people close to the patient had a large influence on the patient's decision. It was clear that the patients' satisfaction level was high.

Effect of the timing of discontinuation of last-line chemotherapy on patient prognosis in advanced and recurrent gastric cancer.

The present study aimed to determine the effect of the timing of treatment discontinuation on the prognosis of patients with advanced and recurrent gastric cancer chemotherapy. Between July 2014 and March 2017, 127 patients who underwent chemotherapy for advanced and recurrent gastric cancer at Ogaki Municipal Hospital (Ogaki, Japan) were examined. To determine factors associated with survival, multivariate analysis using the Cox proportional hazards model, and hazard ratios and their 95% confidence intervals (95% CI) were calculated. The reasons for discontinuation of last-line chemotherapy and the last hospitalization prior to mortality were surveyed. Age (≤51 years), number of treatment lines (≤1 line), and days between last dose of the final chemotherapy regimen and death (≤79 days) were independently and significantly associated with survival in the multivariate analysis. Compared with patients who did not receive chemotherapy in the last 79 days of life, those who received chemotherapy in the last 79 days of life days had a hazard ratio of 1.858 (95% CI, 1.059-3.261; P=0.031) for mortality. A decrease in the performance status was responsible for treatment discontinuation in 51 of 75 cases among patients who received chemotherapy in the last 79 days of life and 9 of 26 cases among patients who did not receive chemotherapy in this duration (P<0.001). Among patients who received chemotherapy in the last 79 days of life, 67 patients were hospitalized prior to mortality; among patients who did not receive chemotherapy in this duration, 15 patients were hospitalized prior to mortality (P<0.001). In conclusion, continuation of chemotherapy until just prior to mortality does not prolong the survival time in patients with advanced and recurrent gastric cancer.

The CDK inhibitor p21 is a novel target gene of ATF4 and contributes to cell survival under ER stress.

Activating transcription factor 4 (ATF4) is well known for its role in the endoplasmic reticulum (ER) stress response. ATF4 also transcriptionally induces multiple effectors that determine cell fate depending on cellular context. In addition, ATF4 can communicate both pro-apoptotic and pro-survival signals. How ATF4 mediates its prosurvival roles, however, requires further investigation. Here, we report that the CDK inhibitor p21 is a novel target gene of ATF4. We identified two ATF4-responsive elements, one of which directly binds ATF4, within the first intron of the p21 gene. Importantly, overexpression of p21 enhances cell survival following ER stress induction, while p21 knockdown increases cell death. These results suggest that p21 induction plays a vital role in the cellular response to ER stress and indicate that p21 is a prosurvival effector of ATF4.

Comparing the cost-effectiveness of FOLFIRINOX, nab-paclitaxel plus gemcitabine, gemcitabine and S-1 for the treatment of metastatic pancreatic cancer.

The recommended chemotherapy regimens for pancreatic cancer include the combination of 5-fluorouracil/leucovorin, oxaliplatin and irinotecan (FOLFIRINOX), nab-paclitaxel (nab-PTX) plus gemcitabine (GEM), GEM alone and tegafur/gimeracil/oteracil potassium (S-1) alone. Although the cost-effectiveness of metastatic pancreatic cancer chemotherapies has been extensively investigated, to the best of our knowledge, no study has specifically compared the cost-effectiveness among FOLFIRINOX, nab-PTX + GEM, GEM and S-1 regimens to date. The aim of the present study was to examine the cost-effectiveness of these four regimens. The expected costs were calculated based on data from patients with metastatic pancreatic cancer who were treated with the FOLFIRINOX, nab-PTX + GEM, GEM alone or S-1 alone. The median survival time (MST) from randomized controlled trials in the literature was used to evaluate the therapeutic effect of these regimens. The cost-effectiveness ratio was calculated using expected costs and MST for these four regimens. The expected costs per patient for the FOLFIRINOX, nab-PTX + GEM, GEM or S-1 regimens were ¥6,361,191.4, ¥4,802,063.6, ¥540,091.4 and ¥528,514.6, respectively, and the cost-effectiveness ratios per month were ¥642,544.6/MST, ¥470,790.5/MST, ¥81,832.0/MST and ¥55,633.1/MST, respectively. In conclusion, the nab-PTX + GEM and FOLFIRINOX regimens were associated with a high therapeutic efficacy and high cost. The GEM regimen exhibited a lower therapeutic efficacy compared with the nab-PTX + GEM and FOLFIRINOX regimens, but the findings of this study indicated that the GEM and S-1 regimens were the most cost-effective regimens.