Assessment of activities of daily living (ADL) is used in the prognosis of terminal cancer patients. The possibility of a relationship between the Barthel index (BI), which is an index of ADLs, and mortality among terminal cancer patients was indicated in the previous study. Using a retrospective analysis of electronic medical records of terminal cancer patients, it was determined which components of the BI had influence on mortality in this study.

This survey was comprised of 126 patients who died of cancer from January 2016 to December 2017. The mortality rate determined on the 30th day post-hospitalization was 77.8％. The relationships between the mortality rate and the BI, and between the mortality rate and individual components of the BI, were analyzed using a multivariate analysis, the Cox proportional hazards model. The median age (min - max) was 77.5 (30 - 96) years, and 65.9％ of the subjects were male. In the group that required total or partial bathing assistance, there was no significant difference in the mortality rate compared to the groups that were able to independently bathe themselves, but significant differences in the mortality rates of other items were recognized among those groups.

These results indicate that involvement in the prognosis of terminal cancer patients might be different among each item of BI.

“LANTUS^® XR Inj. Solostar^® (450 units / 1.5 mL)” is a preparation that tripled the insulin concentration of existing LANTUS^® Inj. Solostar^®. As the volume per insulin unit is reduced to one third, the recommended blank beating units before dosing have been increased to 3 units. However, some patients perform 2-unit blank beating as they use the existing injector. A retrospective investigation identified erroneous operation of blank beating in 9.5％ of outpatients who had been prescribed LANTUS^® XR Inj. Solostar^® at Nagoya Ekisaikai Hospital from April to May 2017. In this study, we investigated if 2-unit blank beating with LANTUS^® XR Inj. Solostar^® is suitable to confirm needle hole clogging and injection of content by naked-eye observation and the amount emitted. Injection of content was confirmed at the second and subsequent 2-unit beatings by naked-eye observation. On the other hand, the emission weighing test with a new needle and syringe barrel revealed that the amount discharged was increased with 2-unit beating and reached the theoretical value at the fourth beating. Based on these results, we concluded that 3-unit blank beating is preferable for LANTUS^® XR Inj. Solostar^®; however, three successive 2-unit blank beatings are helpful to confirm correct installation of the needle and normal movement of the injector.

Patients administered nedaplatin (NDP) and 5-fluorouracil (5-FU) frequently develop severe myelosuppression such as thrombocytopenia and neutropenia. However, predictive factors for thrombocytopenia and neutropenia in patients treated with NDP and 5-FU therapy remain unknown. We conducted a retrospective study. One hundred and fifty-seven cancer patients were initially administered NDP and 5-FU at Nagasaki University Hospital. A multiple logistic regression analysis was performed to identify risk factors for Grade 3-4 neutropenia and thrombocytopenia. The incidence of Grade 3-4 neutropenia and thrombocytopenia was 72.0％ and 43.9％, respectively. The results of the multivariate analysis showed that significant predictors of Grade 3-4 neutropenia were associated with high-dose NDP (> 100 mg/m²) (odds ratio (OR) 6.56, 95％ confidence interval (CI) 2.70 - 17.58, P < 0.001), low neutrophil counts measured just before the treatment (low baseline neutrophil count) (< 4.7 × 10³/μL) (OR 2.53, 95％ CI 1.04 - 6.29, P = 0.041) and low creatinine clearance values at the start of the treatment (low baseline CCr) (< 56.5 mL/min) (OR 3.64, 95％ CI 1.41 - 10.44, P = 0.007). The incidences of Grade 3-4 thrombocytopenia were high-dose NDP (> 100 mg/m²) (OR 4.48, 95％ CI 2.02 - 9.93, P < 0.001) and low baseline CCr (< 61.6 mL/min) (OR 4.49, 95％ CI 2.02 - 9.77, P < 0.001). Platelet and/or neutrophil reductions need to be considered when CCr is low, and neutrophil reductions when the neutrophil count is low as the initial conditions of patients at the time of the administration of NDP and 5-FU therapy.

In this study, we aimed to detect nausea early, reduce nausea and maintain the QOL of patients administered adjuvant chemotherapy with S-1. Therefore, we determined whether PONV (postoperative nausea and vomiting) is a risk factor for nausea in patients treated with S-1 adjuvant chemotherapy. From January 2017 to April 2018, 75 patients who underwent S-1 adjuvant chemotherapy at Ogaki Municipal Hospital were evaluated. Risk factors for nausea in patients administered S-1 adjuvant chemotherapy were examined by multivariate analyses. Twenty-three patients (30.7％) experienced nausea. PONV was not a risk factor for nausea. However, sex (female; odds ratio: 3.98, 95％ CI: 1.11 w- 14.20, P = 0.03),and the loss of more than 9.49％ of weight in both sexes (odds ratio: 3.66, 95％ CI: 1.05 - 12.70, P = 0.04) were risk factors for nausea in S-1 adjuvant chemotherapy. We found that PONV was not a significant risk factor. However, sex (female) and rate of weight-loss significantly increased the risk of nausea associated with S-1 adjuvant chemotherapy.

Anaphylaxis associated with teicoplanin, a glycopeptide antibiotic, which has a safety profile, has rarely been reported. In addition, the cause of teicoplanin anaphylaxis remains unclear. We report teicoplanin-associated anaphylaxis despite no symptom when receiving vancomycin. A 60s-years-old man who received repeated partial pneumonectomy developed lung cancer. Under therapeutic drug monitoring, vancomycin was administered for methicillin resistant Staphylococcus aureus infection from hospitalization Day 5 day. Despite a vancomycin plasma trough level lower than 20 μg/mL, since acute kidney injury developed at hospitalization Day 13, the antimicrobial agent was replaced from vancomycin to teicoplanin. After subsequent first teicoplanin administration, he developed shivering in combination with tachycardia and peripheral cyanosis. Based upon a comprehensive assessment of the overall clinical course, we examined the likelihood and certainty of allergic anaphylaxis. According to the criteria of Savic et al, this symptom was considered as an indeterminate event due to only three criteria including within 15 minutes, ≥ 2 features of anaphylaxis present and alternative diagnosis excluded. In contrast, that was judged as a probable teicoplanin-associated adverse event, where the total of scores was 6, by criteria adopted from the Naranjo probability scale. In this context, while this case could not provide a definitive conclusion regarding anaphylaxis, it may be considered a as teicoplanin-associated adverse event. Clinicians should be aware that the responsiveness to allergy among glycopeptide antimicrobial agents may be different.

Aminoglycosides (AGs) are recommended for therapeutic drug monitoring (TDM) to ensure efficacy and safety. However, in Japan, there are few institutions that are engaged in TDM-guided AGs dosing in all patients. In addition, there are few reports on its usefulness. From August 1, 2016, our hospital has monitored the prescriptions containing AGs by pharmacist. We decided the initial dosing based on the guidelines and established a system to consult with the doctor-in-charge. Interventions in the form of TDM-guided dosing were administered based on the blood concentration results. We investigated the role of TDM by retrospectively comparing the data from 2 years before the intervention with that after the intervention. Eighty-four patients before the intervention and 68 patients after the intervention were included, and the use of each AGs was not found to be significant between the two periods. The blood concentration was found to increase significantly from 42.9％ before the intervention to 60.3％ after the intervention. The target blood concentration achievement rate increased significantly from 9.5％ before the intervention to 35.3％ after the intervention. The median number of days of blood concentration measurement was significantly shortened from 5 days before the intervention to 3 days after the intervention. The incidence of renal injury significantly decreased from 15.5％ before the intervention to 2.9％, but the 30-day mortality rate did not change. From the above results, it is suggested that TDM guide-based intervention by pharmacists leads to appropriate use of AGs and reduces the incidence of renal injury.

Ramucirumab (RAM) plus paclitaxel (PTX) combination therapy is recommended as the second-line therapy for advanced or recurrent gastric cancer in Japan. We examined the association between severe neutropenia induced by RAM + PTX combination therapy and overall survival. Neutropenia and overall survival were investigated in 49 patients who received RAM + PTX combination therapy for advanced or recurrent gastric cancer at the Ogaki Municipal Hospital between September 2015 and February 2019. Cox proportional hazards regression analysis identified severe neutropenia (Grade ≥ 3) (hazard ratio 0.22, 95％ confidence interval 0.07 - 0.68, P = 0.009) and number of treatment courses (≥ 5, hazard ratio 0.15, 95％ confidence interval 0.05 - 0.39, P < 0.001) as prognostic factors for overall survival. The median overall survival time for patients with Grade ≤ 2 and Grade ≥ 3 was 178 (95％ confidence interval 95 - 315) and 395 days (95％ confidence interval 232 - 650), respectively (P = 0.001). Results from the present study suggest that severe neutropenia is associated with greater overall survival in advanced or recurrent gastric cancer.