A combination of routine laboratory findings and vital signs can predict survival of advanced cancer patients without physician evaluation: a fractional polynomial model

IntroductionThere have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model.MethodsA multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method.ResultsData from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation.ConclusionWe developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research

Concept-based teaching and learning for reconstructing the meaning of peace: a practice of integrated study in Hiroshima Global Academy

The aim of this study is to design the peace education unit, which support the students to achieve the two goals: (1) to reconstruct their own notions of peace, and (2) to acquire interdisciplinary concepts and apply them to find and describe the (non-)peaceful situations in our usual life. Therefore, we developed and implemented a concept based inquiry unit (18 class hours) at Hiroshima Global Academy (HiGA) middle school by contextualize the previous unit plan into the integrated learning program on “Global Justice.” As a result, we could choose the six concepts explaining a nonviolent but threatening the peaceful governance, human relation, and agency, demonstrate the social examples to apply them, and set a controversy defining the criteria of peace. The first outcome of this study is that we show the curricular-instructional gatekeeping adjusting to the school context of HiGA. The second is to find the relations between the students' learning of peace concepts and the reconstruction of peace notion

Development and validation of questionnaires for eating‐related distress among advanced cancer patients and families

Background: Eating‐related distress (ERD) is one type of psychosocial distress among advanced cancer patients and family caregivers. Its alleviation is a key issue in palliative care; however, there is no validated tool for measuring ERD. Methods: The purpose of this study was to validate tools for evaluating ERD among patients and family caregivers. The study consisted of a development and validation/retest phase. In the development phase, we made preliminary questionnaires for patients and family caregivers. After face validity and content validity, we performed an exploratory factor analysis and discussed the final adoption of items. In the validation/retest phase, we examined factor validity with an exploratory factor analysis. We calculated Pearson's correlation coefficients between the questionnaire for patients, the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Cachexia 24 (EORTC QLQ‐CAX24) and Pearson's correlation coefficients between the questionnaire for family caregivers and the Caregiver Quality of Life Index‐Cancer (CQOLC) for concurrent validity. We calculated Cronbach's alpha coefficients (Cronbach's alpha) and intraclass correlation coefficients (ICCs) for internal consistency and test–retest reliability. We performed the Mann–Whitney U test between the questionnaires and cancer cachexia based on criteria from the international consensus for known‐group validity. Results: In the development phase, 162 pairs of patients and family caregivers were asked to participate, and 144 patients and 106 family caregivers responded. In the validation/retest phase, 333 pairs of patients and family caregivers were asked to participate, and 234 patients and 152 family caregivers responded. Overall, 183 patients and 112 family caregivers did the retest. Seven conceptual groups were extracted for the ERD among patients and family caregivers, respectively. Patient factors 1–7 correlated with FAACT ACS (r = −0.63, −0.43, −0.55, −0.40, −0.38, −0.54, −0.38, respectively) and EORTC QLQ‐CAX24 (r = 0.58, 0.40, 0.60, 0.49, 0.38, 0.59, 0.42, respectively). Family factors 1–7 correlated with CQOLC (r = −0.34, −0.30, −0.37, −0.37, −0.46, −0.42, −0.40, respectively). The values of Cronbach's alpha and ICC of each factor and all factors of patients ranged from 0.84 to 0.96 and 0.67 to 0.83, respectively. Those of each factor and all factors of family caregivers ranged from 0.84 to 0.96 and 0.63 to 0.84, respectively. The cachexia group of patients had significantly higher scores than the non‐cachexia group for each factor and all factors. Conclusions: Newly developed tools for measuring ERD experienced by advanced cancer patients and family caregivers have been validated

Problems of reproductive function in survivors of childhood‐ and adolescent and young adult‐onset cancer revealed in a part of a national survey of Japan

Abstract Purpose This study aimed to evaluate the current status of reproductive disorders as long‐term complications in adolescent and young adult (AYA) cancer patients by comparing survivors of childhood‐onset with those of AYA‐onset cancer in Japan. Methods We conducted a national survey of AYA cancer survivors and healthy AYAs and analyzed the results from survivors who underwent chemotherapy and reported fertility problems as their current concern. Results Among all of the childhood‐onset survivors, 27 (35.5%; nine males [28.1%] and 18 females [40.9%]) listed reproduction fertility problems as their current concern. Among all AYA‐onset survivors, 25 (69.5%; 1/4 males [25.0%] and 24/32 females [75.0%]) listed these problems as a current concern. In contrast, 96.3% (26/27) of all childhood‐onset cancer survivors and 68.0% (17/25) of all AYA‐onset cancer survivors who received chemotherapy listed these problems as a current concern. Conclusions A considerable number of both childhood‐onset and AYA‐onset cancer survivors, and especially those who had undergone chemotherapy, reported reproductive dysfunction as a delayed complication. It is vitally important to establish a supportive care system both for the patients whose fertility was abolished after the completion of cancer treatment and prophylactically for patients before they begin treatment

Fertility preservation in adolescent and young adult cancer patients: From a part of a national survey on oncofertility in Japan

Abstract Purpose This study evaluated the current status of reproductive disorders and provision of information on oncofertility to female adolescent and young adult (AYA) cancer patients in Japan. Methods A national survey of AYA cancer survivors was conducted. Children were <15 years old, and AYAs were 15‐39 years old. Results from the survivors of other than gynecological disease who underwent chemotherapy were analyzed. Results Among the survivors, 41.4% were concerned about their reproductive function and infertility, and 36.2% were aware of menstrual cycle abnormalities. Among them, 15.5% (n = 20) of all and 21.2% (n = 17) of the AYA‐onset survivors suffered infertility due to chemo‐ or radiotherapy and gave up childbearing. These rates were significantly higher than those of healthy AYAs. Although 80.8% of AYA‐onset survivors answered that they had received information on reproductive function and infertility, only 55.8% had received information on fertility preservation methods. Furthermore, only 22.4% of all and 42.3% of AYA‐onset survivors had received pretreatment information on fertility preservation methods. Conclusions Not a few AYA cancer survivors reported reproductive dysfunction. These findings indicate that information provided on therapy‐related problems before cancer treatment in Japan was insufficient and highlight the need to improve patient decision‐making and support systems for fertility preservation

Development and Application of Digital Content for Elementary Social Studies using Inquiry-Based Learning: An Online Learning Plan for Local Study to Encourage Wide Area Communication of Elementary School Students in the Context of Municipal Mergers

In this paper, we present the results of the development of thirty digital contents in “NONTA Classroom”, for deepening regional understanding. We propose the pedagogical foundations for implementing them in the curriculum of elementary school education. We conceived of an online local study for elementary school social studies, in which the Board of Education mediates between Educational Vison Research Institute (EVRI) of Hiroshima University and elementary schools in Higashi-Hiroshima City. Future research will examine how children’s citizenship and teachers’ curriculum design are improved in the context of actual practice

The impact of cachexia on dietary intakes, symptoms, and quality of life in advanced cancer

Abstract Background The relationships between cachexia stages and the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS) 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns have not been investigated in Asian patients with advanced cancer. Methods This is a multicentre questionnaire survey conducted in palliative and supportive care settings across Japan. Consecutive patients were enrolled. Patient characteristics and anthropometric measurements were obtained. Dietary intakes and nutrition impact symptoms were also assessed. Patients evaluated their quality of life (QOL) using FAACT ACS. Subjects were divided into two groups, that is, pre‐cachexia (non‐cachexia) and cachexia and refractory cachexia (cachexia), based on cancer cachexia criteria from the international consensus. Comparisons were performed using the Mann–Whitney U test or chi‐squared test. To evaluate the relationship between cachexia stages and FAACT ACS 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns, adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were calculated in the logistic models. Results Among 495 patients, 378 (76.4%) responded. Due to missing data, 344 patients were classified into the non‐cachexia group (n = 174) and cachexia group (n = 170), and 318 remained in the analysis of FAACT ACS. The cachexia group had a more impaired performance status, a lower body mass index, and a higher frequency of weight loss in 1 month (P = 0.021, <0.001, and <0.001, respectively). Advancing stages were associated with lack of appetite and reduced dietary intakes (P < 0.001 and P < 0.001, respectively). QOL scores were significantly worse in the cachexia group in FAACT ACS 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns (P < 0.001, P = 0.001, and P < 0.001, respectively). In the models of FAACT ACS 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns, significantly higher adjusted ORs than in the non‐cachexia group were observed in the cachexia group [2.24 (95% CI 1.34–3.77), P = 0.002; 1.77 (95% CI 1.08–2.92), P = 0.024; and 2.18 (95% CI 1.29–3.70), P = 0.004, respectively]. Conclusions FAACT ACS 12‐item, 5‐item anorexia symptoms, and 4‐item anorexia concerns are useful for identifying patients at risk of QOL that deteriorates with advancing stages in this population