Associations of Death at Home with Medical Resources and Medical Activities in Cancer Patients: A Nationwide Study Using Japanese National Database.

BACKGROUND: Over half of the Japanese population hope to spend their last days at home; however, 73.0% die in hospitals. The proportion of deaths due to cancer in hospitals is even higher, at 82.4%, and is also high globally. Therefore, there is an urgent need to establish conditions that fulfill the hopes of patients, especially those with cancer, who hope to spend their last days at home. This study aimed to clarify medical resources and activities that are related to proportion of death at home among cancer patients. METHODS: We used data from the Japanese National Database and public data. Japan's Ministry of Health, Labour, and Welfare provides national data on medical services to applicants for research purposes. Using the data, we calculated the proportion of deaths at home in each prefecture. We also collected information on medical resources and activities from public data and conducted multiple regression analyses to investigate factors associated with the proportion of death at home. RESULTS: In total, 51,874 eligible patients were identified. The maximum and minimum proportions of death at home based on prefectures differed by approximately three-fold (14.8%-41.6%). We also identified scheduled home-visit medical care (coefficient=0.580) and acute and long-term care beds (coefficient=-0.317 and -0.245) as factors that increased and decreased the proportion of death at home, respectively. CONCLUSION: To fulfill the hopes of cancer patients to spend their last days at home, we recommend that the government develop policies to increase home visits by physicians and optimize hospital acute and long-term care beds.

Expression and clinicopathological significance of glucocorticoid receptor, SGK1, and NDRG1 in hormone-naïve prostate carcinoma.

Glucocorticoid receptor (GR) has been implicated in prostate carcinoma growth and progression. Glucocorticoid receptor beta (GRß) acts as an inhibitor of GR; however, its function is not well understood. Serum- and glucocorticoid-regulated kinase 1 (SGK1) is a GR-responsive gene that phosphorylates N-myc downstream-regulated gene 1 (NDRG1) and is involved in cancer growth and invasion. However, the expression of GR, GRß, SGK1, and NDRG1 in prostate cancer and their relationship with clinicopathological and functional significance remain unknown. The association between the status of GR, GRß, SGK1, and NDRG1 immunoreactivity and clinicopathological variables was analyzed in patients with prostate carcinoma to explore their clinical significance. In prostate carcinoma cases, the relative abundance of GR and NDRG1 immunoreactivity was inversely and significantly associated with the primary tumor stage (pT), while GR immunoreactivity was inversely and significantly associated with the Ki-67 score. The relative expression status of NDRG1 was significantly associated with that of GR. However, no significant correlation was observed between any of the clinicopathological parameters and GRß and SGK1 expression. Our findings indicate that GR and NDRG1 expression status is correlated with clinicopathological features in patients with prostate cancer.

Residents in a Remote Island Having Family Members in Distant Areas Showed Higher Preference for Place of End-of-Life Care: The Ajishima Study.

INTRODUCTION: To investigate the proportion of those having preferred place for end-of-life care among residents in a remote island and its association with family composition. METHODS: Cross-sectional questionnaire survey was conducted in Ajishima, an island 23 km away from the coast of Ishinomaki City, northeast of Japan. Between October 2017 and February 2018, the questionnaire was distributed to 288 eligible residents and 113 valid responses were analyzed. Primary outcome was whether the subjects had preferred place for end-of-life care. The explanatory variable was family composition defined as whether having family members inside or outside the island [none (In-/Out-), only inside the island (In+/Out-), only outside the island (In-/Out+), and both inside and outside (In+/Out+)]. Poisson regression analysis was used to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of showing preferred place in each group. RESULTS: The proportion of those having preferred place for end-of-life care was 72.6% in total. This rate significantly differed across family composition groups: 67.6%, 40.0%, and 82.9% for In+/Out+, In+/Out-, and In-/Out+ groups, respectively. The PR (95%CI) of having preferred place was 0.66 (0.33, 1.36) and 1.26 (1.01, 1.56) for In+/Out- and In-/Out+ groups, respectively, compared with In+/Out+ group. CONCLUSIONS: This study showed that significantly higher preference for place of end-of-life care was seen among residents who had family members only outside the island compared with those who had families both inside and outside. Health care professionals should consider family compositions when initiating end-of-life discussion to residents in remote areas.

Identification of Topics Explained by Home Doctors to Family Caregivers with Cancer Patients Died at Home: A Quantitative Text Analysis of Actual Speech in All Visits.

An important consideration in the quality of end-of-life care is whether the patient's place of death matches his or her hopes. We aimed to identify topics related to patients' home death by comparing the occurrence frequency of topics explained by doctors for family caregivers between the home death cases and the hospital death cases. The method of integrating qualitative and quantitative data was adopted in this study. Primary participants were 24 home doctors who specialized home medical care. Enrolled 18 patients received periodical medical care by cooperated doctors, understood their own health situation, and lived with family caregivers. Doctors recorded all their speech during every visit with voice-recorder until the patient died at home or was re-hospitalized. Doctors' speech was transcribed and converted to the number of occurrences based on number of visits. The occurrence frequency was compared with a χ2 test (Yates' correction). Speaking records of 227 visits to 18 patients by doctors were collected. Finally, 16 patients died at home and two died at hospital. We measured the occurrence frequency of topics during maximum 26 visits on 16 home death cases and maximum 13 visits on two hospital death cases. The topics of patients' death, helping daily burden using public insurance, and financial application were more frequently appeared with home death cases than hospital death cases. In conclusion, doctors should explain to family caregivers the topics of patients' death process and specific measures or procedures for reduction in care burden.