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Palliative Care for Patients with Gynecologic Cancer in Japan: A Japan Society of Gynecologic Palliative Medicine (JSGPM) Survey

  • Futagami, Masayuki (Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine) ;
  • Yokoyama, Yoshihito (Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine) ;
  • Sato, Tetsumi (Department of Anesthesiology, Hirosaki University Graduate School of Medicine) ;
  • Hirota, Kazuyoshi (Department of Anesthesiology, Hirosaki University Graduate School of Medicine) ;
  • Shimada, Muneaki (Department of Obstetrics and Gynecology, Tottori University School of Medicine) ;
  • Miyagi, Etsuko (Department of Obstetrics and Gynecology, Yokohama City University Hospital) ;
  • Suzuki, Nao (Department of Obstetrics and Gynecology, St. Marianna University School of Medicine) ;
  • Fujimura, Masaki (Department of Obstetrics and Gynecology, Tokyo Medical University Ibaraki Medical Center)
  • Published : 2016.10.01

Abstract

Purpose: To evaluate palliative care for patients with gynecologic cancer in Japan. Materials and Method: A questionnaire asking facility characteristics, systems to coordinate palliative care, current status of end-of-life care, provision of symptom relief, palliative radiation therapy and chemotherapy, and cases of death from gynecological cancer, was mailed to facilities treating gynecologic cancer. Results: A total of 115 facilities (29.3% of the total) responded to the questionnaire. Of these, 33.0 (29.0%) had a palliative care ward. End-of-life care was managed by obstetricians and gynecologists in 72.0% of the facilities. The site where end-of-life care was provided was most often a ward in the department where the respondent worked. The waiting period for transfer to a hospice was 2 weeks or more in 52% of facilities. Before the start of primary treatment, pain control was managed by obstetrians and gynecologists in 98.0% of facilities. Palliative radiation therapy or chemotherapy was administered at 93.9% and 92.0% of facilities, respectively. Of the 115 facilities, 34.0 (29.6%) reported cases of death from gynecological cancer. There were 1,134 cases of death. The median time between the last cycle of chemotherapy and death was 85 days for all gynecological cancers. The proportion of patients receiving chemotherapy in the last 30 and 14 days of life were 17.4% and 7.1%, respectively. Conclusions: This large-scale survey showed characteristics of palliative care given to patients with gynecologic cancer in Japan. Assessment of death cases showed that the median time between the last cycle of chemotherapy and death was relatively short.

Keywords

Palliative care;gynecologic cancer;palliative chemotherapy;anonymous questionnaire;death cases

References

  1. Barbera L, Elit L, Krzyzanowska M et al (2010) End of life care for women with gynecologic cancers. Gynecol Oncol,118,196-201. https://doi.org/10.1016/j.ygyno.2010.04.014
  2. Cheung MC, Earle CC, Rangrej J et al (2015) Impact of aggressive management and palliative care on cancer costs in the final month of life. Cancer, 121, 3307-15. https://doi.org/10.1002/cncr.29485
  3. De Meerleer G, Vandecasteele K, Ost P et al (2011) Whole abdominopelvicradiotherapy using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease: a single-institution experience. Int J Radiat Oncol Biol Phys, 79,775-81. https://doi.org/10.1016/j.ijrobp.2009.11.039
  4. Donovan KA, Greene PG, Shuster JL. (2002) Treatment preferences in recurrent ovarian cancer. Gynecol Oncol, 86, 200-11. https://doi.org/10.1006/gyno.2002.6748
  5. Fauchi J, Schneider K, Walters C et al (2012) The utilizeation of palliateive care in gynecologic oncology patients near the end of life. Gynecol Oncol, 127, 175-79. https://doi.org/10.1016/j.ygyno.2012.06.025
  6. Japanese Society for Palliative Medicine (2014) The 2014 White Paper on Hospices from palliative care teams. 2014 edition, Seikaisha, LTD, Tokyo.
  7. Hashimoto K, Yonemori K, Katsumata N et al (2009) Factors that affect the duration of the interval between the completion of palliative chemotherapy and death. Oncologist, 14, 752-59. https://doi.org/10.1634/theoncologist.2008-0257
  8. Kao S, Shafig J, Vardy J et al (2009) Use of chemotherapy at end of life in oncology patients. Ann Oncol, 20,1555-59. https://doi.org/10.1093/annonc/mdp027
  9. Keyser EA, Reed BG, Lowery WJ et al (2010) Hospice enrollent for terminally ill patients with gynecologic cancer: Impact on outcomes and intervenetions. Gynecol Oncol ,118, 274-77. https://doi.org/10.1016/j.ygyno.2010.05.021
  10. Kobold S, Hegewisch-Becker S, Oechsle K et al (2009) Intraperitoneal VEGF inhibition using bevacizumab: a potential approach for the symptomatic treatment of malignant ascites? Oncologist, 14, 1242-51. https://doi.org/10.1634/theoncologist.2009-0109
  11. Lowery WJ, Lowery AW, Barnett JC et al (2013) Cost-effectiveness of early palliative care intervention in recurrent platinum-resistant ovarian cancer. Gynecol Oncol, 130, 426-30. https://doi.org/10.1016/j.ygyno.2013.06.011
  12. Mack JW, Cronin A, Keating NL et al (2012) Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study. J Clin Oncol 30, 4387-95. https://doi.org/10.1200/JCO.2012.43.6055
  13. Maeda S, Yabuuchi J, Nobuta H et al (2015) Characteristics of Patients and Their Ascites Who Underwent Repeated Cell-Free and Concentrated Ascites Reinfusion Therapy. Ther Apher Dial, 19, 342-48. https://doi.org/10.1111/1744-9987.12343
  14. Makino H, Nishio S, Tsubamoto H et al (2016) Treatment and prognosis of bone metastasis from cervical cancer (KCOG-G1202s). J Obstet Gynaecol Res, doi: 10.1111/jog.12956.
  15. Mohsen H, Haddad P, Allam A et al (2014) Patterns in place of cancer death in the state of Quatar; A population-based Study. PLoS ONE, 9, e109615. https://doi.org/10.1371/journal.pone.0109615
  16. Morita T, Miyashita M, Tsuneto S et al (2009) Late referrals to palliative care units in Japan: nationwide follow-up survey and effects of palliative care team involvement after the Cancer Control. Act J Pain Symptom Manage, 38, 191-96. https://doi.org/10.1016/j.jpainsymman.2008.09.011
  17. Murakami N, Tanabe K, Morita T et al (2015) Going back to home to die: dose it make a difference to patient survival. BMC Palliative care 14:7 doi 10.1186/s12904-015-0003-5. https://doi.org/10.1186/s12904-015-0003-5
  18. Nappa U, Lindqvist O, Rasmussen B.H et al (2011) Palliative chemotherapy during the last month of life. Ann Oncol, 22, 2375-80. https://doi.org/10.1093/annonc/mdq778
  19. Nevadunsky NS, Gordon S, Spoozak L et al (2014) The role and timing of palliative medicine consultation for women with gynecologic cancer: association with end of life interventions and direct hospital costs. Gynecol Oncol, 132, 3-7. https://doi.org/10.1016/j.ygyno.2013.10.025
  20. Pujade-Lauraine E, Hilpert F, Weber B et al (2014) Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: The AURELIA open-label randomized phase III trial. J Clin Oncol, 32, 1302-8. https://doi.org/10.1200/JCO.2013.51.4489
  21. Ramondetta LM, Tortolero-Luna G, Bodurka DC et al (2014) Approaches for end-of-life care in the field of gynecologic oncology: an exploratory study. Int J Gynecol Cancer, 14, 580-88.
  22. Saito AM, Landrum MB, Neville BA et al (2011) The effect on survival of continuing -chemotherapy to near death. BMC Palliat Care, 21,10-14.
  23. Von Gruenigen VE, Daly BJ (2005) Futility: clinical decisions at the end-of-life in women with ovarian cancer. Gynecol Oncol, 97,638-44. https://doi.org/10.1016/j.ygyno.2005.01.031
  24. Wang L, Okubo T, Shinsaka M et al (2015) Efficacy and safety of cell-free and concentrated ascites reinfusion therapy (CART) in gynecologic cancer patients with a large volume of ascites. J Obstet Gynaecol Res, 41, 1614-20. https://doi.org/10.1111/jog.12763
  25. Wright AA, Keating NL, Balboni TA et al (2010) Place of death: Correlations with quality of life of patients with cancer and predictors of Bereaved caregiver's mental health. J Clin Oncol, 28, 4457-64. https://doi.org/10.1200/JCO.2009.26.3863