Patient-related Factors Contributing to Shorter Prognosis than Oncologist’s Estimation of Survival in Terminal Cancer

Objective: To investigate the factors that make observed survival of patients with terminal cancer shorter than oncologists’ estimation. Methods: We retrospectively surveyed the medical records of terminal cancer patients who were referred to our palliative care unit with a predicted survival of 1–3 months and discharged dead from hospital within 3 months. Results: A total of 249 patients were eligible for analysis. One hundred and two patients (41%) had observed survival of less than one month (OS1), and 147 (59%) lived for 1–3 months (OS1–3) as expected. Depressed level of consciousness above Japan Coma Scale II and severely reduced oral intake (a few mouthfuls or less) were associated with unexpected shorter survival. The number of patients who died within two days after sudden deterioration of general condition was significantly higher in OS1 than OS1–3. Conclusion: Although survival of patients with the above factors may be shorter than oncologists’ estimation, it is necessary to examine the physician-side factors that contribute to the inaccuracy of prognosis.

Additive effect of rikkunshito, an herbal medicine, on chemotherapy-induced nausea, vomiting, and anorexia in uterine cervical or corpus cancer patients treated with cisplatin and paclitaxel: results of a randomized phase II study (JORTC KMP-02) / 부인종양

OBJECTIVE: Rikkunshito, an herbal medicine, is widely prescribed in Japan for the treatment of anorexia and functional dyspepsia, and has been reported to recover reductions in food intake caused by cisplatin. We investigated whether rikkunshito could improve chemotherapy-induced nausea and vomiting (CINV) and anorexia in patients treated with cisplatin. METHODS: Patients with uterine cervical or corpus cancer who were to receive cisplatin (50 mg/m² day 1) and paclitaxel (135 mg/m² day 0) as first-line chemotherapy were randomly assigned to the rikkunshito group receiving oral administration on days 0–13 with standard antiemetics, or the control group receiving antiemetics only. The primary endpoint was the rate of complete control (CC: no emesis, no rescue medication, and no significant nausea) in the overall phase (0–120 hours). Two-tailed p<0.20 was considered significant in the planned analysis. RESULTS: The CC rate in the overall phase was significantly higher in the rikkunshito group than in the control group (57.9% vs. 35.3%, p=0.175), as were the secondary endpoints: the CC rate in the delayed phase (24–120 hours), and the complete response (CR) rates (no emesis and no rescue medication) in the overall and delayed phases (63.2% vs. 35.3%, p=0.095; 84.2% vs. 52.9%, p=0.042; 84.2% vs. 52.9%, p=0.042, respectively), and time to treatment failure (p=0.059). Appetite assessed by visual analogue scale (VAS) appeared to be superior in the rikkunshito group from day 2 through day 6. CONCLUSION: Rikkunshito provided additive effect for the prevention of CINV and anorexia.