Japanese Journal of Clinical Oncology

doi: 10.1093/jjco/hys156pmid: N/A

Shin, Hai-Rim; Carlos, Marie Clem; Varghese, Cherian

doi: 10.1093/jjco/hys077pmid: 22661171

Cancer is becoming an increasingly important health problem in the low- and middle-income countries in the Asia Pacific region, as well as in high-income countries because of ageing populations and changes in lifestyle associated with economic development and epidemiologic transition. This paper reviews the cancer burden and control in the Asia Pacific region (limited to East Asia, South Eastern Asia and Pacific Islands countries, territories and other areas), with relevant information primarily extracted from the GLOBOCAN 2008, Cancer Incidence in Five Continents series and WHO websites. Most low- and middle-income countries have a cancer control strategy and/or an action plan; however, coverage of cancer registration is still very low and does not meet the international standard in terms of quality. Therefore, only limited data were available for the recent global estimation of cancer burden. Large variations, in both cancer incidence and mortality, were observed in the populations in the different sub-regions of Asia. The most common cancer in males is lung cancer in the Eastern and South Eastern sub-regions, while prostate cancer comes close to lung cancer in the Pacific Island countries. In females, breast cancer is the most common in all three regions. The predominance of lung, stomach, colorectal, prostate, breast and cervical cancers makes cancer control more amenable in the Asia Pacific region. Up-to-date statistics on cancer occurrence and outcome are essential for the planning and evaluation of cancer control programmes. Priority can be given to population-based cancer registration, risk reduction, especially tobacco control, and primary health care based enhancement of health care systems to diagnose and manage cancer specifically in low- and middle-income countries.

Uchinuno, Atsuko

doi: 10.1093/jjco/hys139pmid: 22941586

This article reviews recent cancer nursing research in Japan and the USA, and topics relating to international cancer nursing societies. Most of the articles on cancer nursing published in Japan are in the Journal of the Japanese Society of Cancer Nursing. A total of 46 articles have been published over 3 years from 2009, and many of these are qualitative studies aimed at understanding the response of cancer patients to disease along with their symptoms and backgrounds. The International Society of Nurses in Cancer Care (ISNCC) holds a conference biennially, at which cancer nursing research is presented by researchers from around the world. Many pieces of research on the topics of the symptomatic management and health impact of smoking and cancer screening are discussed. Also, at the Congress of the Oncology Nursing Society (ONS), the world's largest cancer nursing society in the USA, a nation advanced in the field of cancer nursing, symptomatic management has already been discussed; however, the topics have been shifting from nausea, vomiting and pain to adverse events induced by novel treatments such as skin alterations, peripheral neuropathy and fatigue. Cancer nursing research is not yet fully mature in terms of the number and range of articles. In nursing research, it is difficult to measure a patient's response to their disease because it includes psychosocial response; the results are difficult to claim as scientific evidence. Therefore, it is still necessary to conduct research with detailed descriptions of clinical phenomena and to develop cancer nursing research, including actual study methodologies.

Nagane, Motoo; Nishikawa, Ryo; Narita, Yoshitaka; Kobayashi, Hiroyuki; Takano, Shingo; Shinoura, Nobusada; Aoki, Tomokazu; Sugiyama, Kazuhiko; Kuratsu, Junichi; Muragaki, Yoshihiro; Sawamura, Yutaka; Matsutani, Masao

doi: 10.1093/jjco/hys121pmid: 22844129

ObjectiveThis single-arm, open-label, Phase II study evaluated the efficacy and safety of single-agent bevacizumab, a monoclonal antibody against vascular endothelial growth factor, in Japanese patients with recurrent malignant glioma.MethodsPatients with histologically confirmed, measurable glioblastoma or World Health Organization Grade III glioma, previously treated with temozolomide plus radiotherapy, received 10 mg/kg bevacizumab intravenous infusion every 2 weeks. The primary endpoint was 6-month progression-free survival in the patients with recurrent glioblastoma.ResultsOf the 31 patients enrolled, 29 (93.5%) had glioblastoma and 2 (6.5%) had Grade III glioma. Eleven (35.5%) patients were receiving corticosteroids at baseline; 17 (54.8%) and 14 (45.2%) patients had experienced one or two relapses, respectively. The 6-month progression-free survival rate in the 29 patients with recurrent glioblastoma was 33.9% (90% confidence interval, 19.2–48.5) and the median progression-free survival was 3.3 months. The 1-year survival rate was 34.5% with a median overall survival of 10.5 months. There were eight responders (all partial responses) giving an objective response rate of 27.6%. The disease control rate was 79.3%. Eight of the 11 patients taking corticosteroids at baseline reduced their dose or discontinued corticosteroids during the study. Bevacizumab was well-tolerated and Grade ≥3 adverse events of special interest to bevacizumab were as follows: hypertension [3 (9.7%) patients], congestive heart failure [1 (3.2%) patient] and venous thromboembolism [1 (3.2%) patient]. One asymptomatic Grade 1 cerebral hemorrhage was observed, which resolved without treatment.ConclusionSingle-agent bevacizumab provides clinical benefit for Japanese patients with recurrent glioblastoma.

Nakamura, Kenichi; Shibata, Taro; Takashima, Atsuo; Yamamoto, Seiichiro; Fukuda, Haruhiko

doi: 10.1093/jjco/hys122pmid: 22844128

ObjectiveProgression-free survival is an often-used endpoint in clinical trials comparing preoperative therapy and surgery-first therapy. Because the surgery date is always later in the preoperative arm than in the surgery-first arm, it is difficult to define progression-free survival optimally. We evaluated three progression-free survival definitions that used different methods to handle incomplete resection.MethodsThe three definitions specify the event date of incomplete resection (IR) as follows: ‘IR = event’ method, date of surgery; ‘IR not event’ method, date of radiological or clinical progression after incomplete resection; landmark method, landmark time. According to these definitions, the theoretical strengths and weaknesses of the three definitions are investigated. Three patterns of progression-free survival and overall survival were estimated using the data of the Japan Clinical Oncology Group studies.ResultsTheoretically, ‘IR = event’ inflates alpha error while ‘IR not event’ method and landmark method reduce the statistical power under the alternative hypothesis. In JCOG9907, hazard ratios for the three definitions were: ‘IR = event’, 0.80 (95% confidence interval, 0.59–1.07; P = 0.13); ‘IR not event’, 0.81 (95% confidence interval, 0.60–1.09; P = 0.16); landmark, 0.80 (95% confidence interval, 0.59–1.07; P = 0.15). No P value of any methods corresponded with the positive result for overall survival (P = 0.03). In the preoperative arms of the four studies, maximum differences in median and percentage of 1 year progression-free survival among the three definitions were 0–6.4 months and 1.2–5.2%.ConclusionsProgression-free survival sometimes fails as a surrogate of overall survival, and differences among results obtained with various progression-free survival definitions can be large. Overall survival should be used as primary endpoint in studies evaluating preoperative therapy.

Ito, Tetsuhide; Okusaka, Takuji; Ikeda, Masafumi; Igarashi, Hisato; Morizane, Chigusa; Nakachi, Kohei; Tajima, Takeshi; Kasuga, Akio; Fujita, Yoshie; Furuse, Junji

doi: 10.1093/jjco/hys123pmid: 22859827

ObjectiveEverolimus, an inhibitor of the mammalian target of rapamycin, has recently demonstrated efficacy and safety in a Phase III, double-blind, randomized trial (RADIANT-3) in 410 patients with low- or intermediate-grade advanced pancreatic neuroendocrine tumours. Everolimus 10 mg/day provided a 2.4-fold improvement compared with placebo in progression-free survival, representing a 65% risk reduction for progression. The purpose of this analysis was to investigate the efficacy and safety of everolimus in the Japanese subgroup enrolled in the RADIANT-3 study.MethodsSubgroup analysis of the Japanese patients was performed comparing efficacy and safety between everolimus 10 mg/day orally (n = 23) and matching placebo (n = 17). The primary endpoint was progression-free survival. Safety was evaluated on the basis of the incidence of adverse drug reactions.ResultsProgression-free survival was significantly prolonged with everolimus compared with placebo. The median progression-free survival was 19.45 months (95% confidence interval, 8.31–not available) with everolimus vs 2.83 months (95% confidence interval, 2.46–8.34) with placebo, resulting in an 81% risk reduction in progression (hazard ratio, 0.19; 95% confidence interval, 0.08–0.48; P< 0.001). Adverse drug reactions occurred in all 23 (100%) Japanese patients receiving everolimus and in 13 (77%) patients receiving placebo; most were grade 1/2 in severity. The most common adverse drug reactions in the everolimus group were rash (n = 20; 87%), stomatitis (n = 17; 74%), infections (n = 15; 65%), nail disorders (n = 12; 52%), epistaxis (n = 10; 44%) and pneumonitis (n = 10; 44%).ConclusionsThese results support the use of everolimus as a valuable treatment option for Japanese patients with advanced pancreatic neuroendocrine tumours.

Nishiyama, Yuji; Tateishi, Ukihide; Kawai, Akira; Chuman, Hirokazu; Nakatani, Fumihiko; Miyake, Mototaka; Terauchi, Takashi; Inoue, Tomio; Kim, Edmund E.

doi: 10.1093/jjco/hys116pmid: 22850222

ObjectiveThe aim of this study was to investigate the prognostic implications of 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in patients with chest wall sarcoma.MethodsPositron emission tomography/computed tomography scans of 42 patients (mean age: 46 years) with chest wall sarcomas were analyzed. Pathologic confirmation was obtained by surgical specimens in all patients. Tumor grade assessed by Ki-67 (MIB-1) immunohistochemical analysis and expression of glucose transporter protein 1 were compared with a maximum standardized uptake value. Univariate and multivariate analyses were conducted for estimates of overall and event-free survivals.ResultsThe median maximum standardized uptake value of the tumor was 10.2 and the median MIB-1 index of the tumor was 32.5%. Glucose transporter protein 1 expression was found in 29 patients (69%). Univariate analyses revealed that surgery, chemotherapy, MIB-1 labeling index (cut-off 32.5%), MIB-1 grade, glucose transporter protein 1 expression and maximum standardized uptake value were possible predictors for overall and event-free survival. Multivariate analysis revealed that surgery (hazard ratio, 4.852; P = 0.017), maximum standardized uptake value (hazard ratio, 3.077; P = 0.037) and MIB-1 labeling index (hazard ratio, 6.549; P = 0.003) were independent predictors of event-free survival. In addition, surgery (hazard ratio, 4.092; P = 0.021) and maximum standardized uptake value (hazard ratio, 2.968; P = 0.027) were independent predictors of overall survival.Conclusions18F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography allows the prediction of prognosis after treatment in patients with chest wall sarcoma and may be useful in selecting high-risk patients for more risk-adapted treatments.

Takahashi, Miyako; Kai, Ichiro; Muto, Takashi

doi: 10.1093/jjco/hys125pmid: 22850223

BackgroundThis study investigates discrepancies between Japanese public perceptions and epidemiological facts regarding cancer prognosis and lifetime incidence, as well as factors that correlate with public perceptions.MethodsWe conducted a cross-sectional Internet survey with 2369 Japanese survey registrants without a history of cancer. Survey registrants were selected so that distributions of gender, age and place of residence (prefecture) reflected 2010 national census data as much as possible. The questionnaire included questions about their perceptions of 5-year survival rates for cancer in general and 19 site-specific cancers, as well as their perceptions of cumulative lifetime cancer incidence rate among Japanese men and women.ResultsThe distribution of respondent answers regarding the 5-year survival rate for cancer in general and 19 site-specific cancers varied widely from epidemiological data. Multiple regression analyses revealed that in some cancers, respondents who were of older age, who were female and who had a family/friend with a cancer history were significantly more likely to provide higher estimates regarding the 5-year survival rates. Respondents who correctly estimated cumulative lifetime cancer incidence rates among Japanese men and women were 8.5 and 33.1%, respectively. Respondents who were young, who had a higher educational background and who had a family/friend with a cancer history were significantly more likely to provide higher estimates of cumulative lifetime cancer incidence rates.ConclusionsOur study revealed wide discrepancies between Japanese public perceptions and epidemiological facts for cancer prognosis and incidence. Accordingly, more efforts should be made to bridge the gap between incorrect perceptions and epidemiological facts.

Kiyota, Naomi; Tahara, Makoto; Okano, Susumu; Kawashima, Mitsuhiko; Matsuura, Kazuto; Onozawa, Yuske; Nibu, Kenichi; Hayashi, Ryuichi; Yoshimura, Kenichi; Ohtsu, Atsushi

doi: 10.1093/jjco/hys128pmid:

Hsieh, Vivian Chia-Rong; Wu, Trong-Neng; Liu, Shu-Hui; Shieh, Shwn-Huey

doi: 10.1093/jjco/hys113pmid: 22826351

ObjectiveLung cancer is not only one of the most prevalent cancers but is also a lethal disease with a very low 5-year survival rate. Delay in diagnosis further reduces the chance of early treatment and worsens patients' survival. The purpose of this study was to understand the delay in the diagnosis of lung cancer under the healthcare system in Taiwan, and to identify the factors associated with it.MethodsA total of 840 patients diagnosed with lung cancer who had completed or were undergoing cancer treatments were recruited from a medical center in central Taiwan from July 2007 to January 2011. Structured questionnaires were administered regarding demographic characteristics, factors associated with their time to diagnosis and the length of delay in days.ResultsMean age was 62.68 years with 52.16 days to diagnosis on average. Number of hospital visits before confirmation of diagnosis differed significantly with the level of healthcare institution initially visited (P < 0.001). Compared with patients who had three or more hospital visits, patients who only visited two and one hospital(s) had a significant 34.91-day (95% confidence interval: 16.29–53.53) and 42.25-day (95% confidence interval: 20.76–63.76) reduction in their time to diagnosis (P < 0.001).ConclusionsAs the number of hospital visits increased, the delay in diagnosis also increased. It is vital to shorten the time to diagnosis for lung cancer patients by limiting the number of medical visits and educating the public to restrict excessive use of medical resources and strengthen their trust in medical professionals.