Cancer Patients In Japan Research Articles

"3-Day Surprise Question" to predict prognosis of advanced cancer patients with impending death: Multicenter prospective observational study.

BackgroundThe study aimed to clarify the efficacy of the “3‐Day Surprise Question (3DSQ)” in predicting the prognosis for advanced cancer patients with impending death.Patients and MethodsThis study was a part of multicenter prospective observational study which investigated the dying process in advanced cancer patients in Japan. For patients with a Palliative Performance Scale ≤20, the 3DSQ “Would I be surprised if this patient died in the next 3 days?” was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis.ResultsAmong the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the “Not surprised” group, 636 patients died within 3 days. Among 232 (16.4%) patients of “Yes surprised” group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO2 ≥ 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected.ConclusionsThe 3‐Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death.

Clinicopathological characteristics, practical treatments, prognosis, and clinical issues of older breast cancer patients in Japan.

Minimal data are available to support the clinical management of older breast cancer patients. Consequently, the standard of care remains unclear. Our aim was to clarify the clinicopathological characteristics, practical treatments, and prognosis of older Japanese breast cancer patients and discuss clinical issues. We reviewed 132,240 cases, diagnosed between 2004 and 2011, from the Japanese Breast Cancer Registry. Focusing on older patients, we compared data among three age groups: 75years and over (n = 27,385), 65-74years (n = 43,839), and 55-64years (n = 61,016). Data revealed the proportions of mucinous and apocrine carcinoma were higher in older patients, and they more frequently had clinical stage II and III cancer. Their ER-positive rates were higher, in contrast to the lower HER2-positive, breast-conserving surgery (BCS), post-BCS irradiation, and adjuvant chemotherapy rates. Almost half of the older patients who underwent chemotherapy received CMF or oral 5FU, during hormone therapy, Tamoxifen was administered more frequently. The overall survival rate decreased with age, but the breast cancer-specific survival (BCSS) at 5years remained similar. The rate of other cause of death in the oldest group was about a half, and more than double that in those aged 55-64years. We showed clinical data of older breast cancer patients in Japan. Their disease was more advanced at the time of diagnosis, post-BCS irradiation and primary systemic chemotherapy were omitted more frequently, and overall, BCSS was similar among age categories, although the rate of other causes of death was higher.

Factors associated with humanistic burden and indirect cost among patients with cancer in Japan

Aims Patients with cancer experienced reduced health-related quality-of-life (HRQoL), increased work productivity and activity impairment (WPAI), and indirect costs. With the current emphasis on economic evaluation of health technology in Japan, it is important to understand how indirect costs correlate with HRQoL and patient characteristics. It is also crucial to assess the patient characteristics associated with the HRQoL, WPAI, and indirect costs among patients with any types of cancer. Materials and methods This cross-sectional study used data from the 2017 Japan National Health and Wellness Survey (NHWS). Respondents self-reported their HRQoL and WPAI by answering validated SF-12v2 and WPAI questionnaires, respectively. Indirect costs were derived using the human capital method. Correlation between HRQoL components and indirect costs were assessed using Spearman’s rank-order correlation. Correlation between patient characteristics and HRQoL, WPAI, and indirect costs were analyzed using generalized linear models. Results A total of 1,540 patients with any types of cancer, 254 with breast cancer, and 144 with colorectal cancer were included in the analyses. There was significant negative correlation between the indirect costs and HRQoL components among patients with any types of cancer. Patients with lower comorbid burden, higher household income, employed, married, or living with partner, never smokers, and exercised tended to have higher HRQoL. Being never smokers, having lower comorbid burden, normal weight, and exercised were associated with lower WPAI measures. Additionally, patients who were older, not married, not obese, and not smoking tended to incur lower indirect costs. Conclusions The negative correlation between HRQoL and indirect costs among patients with cancer emphasized the needs to improve health outcomes and reduce indirect costs of patients. The factors associated with cancer burden identified in this study provide insights to allow targeted intervention to improve HRQoL and lessen the WPAI and indirect cost among cancer patients in Japan.

Factors related to satisfaction of cancer patients with transfer arrangements made by university hospitals at the end-of-life in Japan: a cross-sectional questionnaire survey of bereaved family members.

Cancer patients in university hospitals often face a difficult decision regarding transfer to other care settings at the end-of-life. Arrangements for a satisfying transfer are important for reducing the psychosocial impact of the transition, but few studies have evaluated this aspect. This study aimed to identify factors related to the satisfying arrangement of transfers to other care settings from university hospitals. A total of 400 bereaved family members of cancer patients in Japan participated in this cross-sectional web-based questionnaire survey. Statistical methods including decision tree analysis were conducted to identify factors significantly associated with satisfying transfer arrangements. More than 60% of cancer patients were satisfied with the transfer arrangements made by university hospitals. Decision tree analysis revealed that the factor most significantly associated with satisfaction with transfer arrangements was "satisfaction with contents of the explanation about transfer." The following significant factors were also extracted: "timing of being informed of transfer," "presence of primary care physician," and "presence of trustworthy staff." "Satisfaction with overall care from university hospital staff" and "involvement of palliative care team" were identified as factors contributing to a high degree of satisfaction with transfer arrangements. In order to make satisfying transfer arrangements from university hospitals for cancer patients at the end-of-life, healthcare professionals should provide satisfactory explanations about the transfer process in order to meet the information needs of patients. To be effective, healthcare professionals should initiate transfer arrangements prior to cancer treatment, while simultaneously building trusting relationships with patients.

Trends and characteristics of fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer in Japan: A survey by the gynecologic oncology committee of Japan Society of Obstetrics and Gynecology

Objective: Fertility-sparing treatment is an option for young patients with atypical endometrial hyperplasia (AEH) and endometrial cancer. However, its clinical features and current trends in treatment are relatively unknown in Japan. In this study, we aimed to collect and analyze nationwide data on fertility-sparing treatment for AEH and endometrial cancer patients in Japan. The objective of this study was to examine pathological complete remission (CR) rates and trends in fertility-sparing treatment for young AEH and endometrial cancer patients in Japan.

PMD9 Cost-Minimization Analysis of Robotic-Assisted Surgery for Gastric Cancer Patients in JAPAN

The Robotic assisted surgical procedure had only been reimbursed for prostate / renal cancer patients under Japanese health insurance system. In 2018 it was expanded to twelve other disease areas, while no premium is given for extended area. Gastrectomy is thought to be important procedure among 12 ones in East Asia, as gastric cancer is more prevalent than that in Europe / the US. Our objective is to compare average length of stay (ALOS) and medical expenses among different surgery methods, or robotic-assisted, conventional, and open gastrectomy.

PMD10 Cost-Utility Analysis of Robotic-Assisted Surgery for Prostate Cancer Patients in JAPAN

PMD10 Cost-Utility Analysis of Robotic-Assisted Surgery for Prostate Cancer Patients in JAPAN

Results from a 1-day workshop on the assessment of quality of life in cancer patients: a joint initiative of the Japan Clinical Oncology Group and the European Organisation for Research and Treatment of Cancer.

This report summarizes the presentations and discussion in the first Japan Clinical Oncology Group-European Organisation for Research and Treatment of Cancer Quality of Life/Patient-Reported Outcome workshop funded by the National Cancer Center Hospital that was held on Saturday, 1 September 2018 in Tokyo, Japan. The infrastructure and understanding regarding the Quality of Life/Patient-Reported Outcome assessment of cancer patients in Japan is still immature, in spite of the increased demand for oncological Patient-Reported Outcome research felt not only by researchers but also by patients or other stakeholders of cancer drug development. The workshop aimed to share each perspective, common issues to be considered and future perspectives regarding the strong alliance between the European Organisation for Research and Treatment of Cancer Quality of Life Group and the Japan Clinical Oncology Group for Quality of Life/Patient-Reported Outcome research as well as explore the possibility of conducting collaborative research. European Organisation for Research and Treatment of Cancer is a leading international cancer clinical trials organization, and its Quality of Life Group is a global leader in the implementation of Quality of Life research in cancer patients. The three invited speakers from the European Organisation for Research and Treatment of Cancer Quality of Life Group presented their perspective, latest methodology and ongoing projects. The three speakers from the Japan Clinical Oncology Group presented their current status, experience and some issues regarding data management or interpretation of the Patient-Reported Outcome data. The two patient advocates also shared their expectations in terms of advances in cancer research based on the Patient-Reported Outcome assessment. As the next steps after this workshop, the Japan Clinical Oncology Group and European Organisation for Research and Treatment of Cancer have decided to cooperate more closely to facilitate Patient-Reported Outcome research in both the groups, and the Japan Clinical Oncology Group has approved the establishment of a new committee for Quality of Life/Patient-Reported Outcome research in Japan.

Clinical impact of non-predominant histopathological subtypes on the long-term prognosis of colorectal cancer patients in Japan.

We performed a retrospective study to clarify the long-term prognosis of patients with histopathological high-grade colorectal cancer (CRC). We reviewed data from 24 institutions for 18,360 patients with pStage I to III CRC who had undergone curative surgery between 2004 and 2012. The patients were classified into seven groups according to the proportion of the histopathological component: classical adenocarcinoma (CAC) group, M-l and M-h groups (< 50% and ≥ 50% mucinous adenocarcinoma, respectively), P-l and P-h groups (< 50% and ≥ 50% poorly differentiated adenocarcinoma, respectively), and S-l and S-h groups (< 50% and ≥ 50% signet-ring cell carcinoma (SRCC), respectively). The 5-year recurrence-free survival (RFS) rates of the M-l, P-l, and S-l groups were 75.5%, 68.4%, and 52.4%, respectively, and were significantly lower than those of the CAC group (83.5%, hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.01-1.48, p = 0.0365; HR 1.60, 95% CI 1.32-1.91, p < 0.0001; HR 2.61, 95% CI 1.30-4.57, p = 0.0090, respectively). The 5-year RFS of the P-l and S-l groups was as poor as that of the P-h and S-h groups, respectively (HR 0.87, 95% CI 0.68-1.10, p = 0.25; HR 0.90, 95% CI 0.37-2.13, p = 0.81, respectively). The histopathological component of the S-l group was an independent factor affecting overall survival in multivariate analysis. The long-term prognoses of the non-predominant poorly differentiated adenocarcinoma (PAC) groups were as poor as those of the predominant group. In particular, the histopathological component of the P-l and S-l groups could be classified into predominant PAC and SRCC subtypes for appropriate prognostic predictions.

Understanding help-seeking behaviour in relation to psychosocial support services among Japanese cancer patients.

There are various psychosocial support services for cancer patients in Japan; however, their utilization rate is lower than in Western countries. The aim of this study was to investigate the actual status of the utilization of such services and the related factors of their use, using the transtheoretical model. We conducted an Internet survey of cancer outpatients. They were asked for information on their demographics, physical status and the usage of and intention to use psychosocial support services, and to answer the Hospital Anxiety and Depression Scale. Data of 712 participants were analyzed; 111 had made use of psychosocial support services (15.6%). Participants who were younger, female, had breast cancer, experience with hormone therapy and did not have a good performance status (Karnofsky Performance Scale) more often used such services when comparing users/experiencers with non-users/inexperienced. Of the inexperienced, 538 were in the Precontemplation stage (89.5%), 62 were in the Contemplation stage (10.3%) and one was in the Preparation stage (0.2%). Approximately 35% of those in the Precontemplation stage would correspond to adjustment disorders or major depression. We showed the degree of cancer patients who have used the psychosocial support services and its contents and revealed the factors related to the utilization of such services in Japan. Our study supports previous reports that cancer patients with high levels of distress do not necessarily seek support, and thus future studies should also examine other modifiable factors considering the medical settings.

Characteristics of penile cancer in Japan: An analysis of nationwide hospital-based cancer registry data.

To investigate the clinical characteristics of patients with penile cancer in Japan using the nationwide hospital-based cancer registry database. Using hospital-based cancer registry data, we described the distribution of age, pathology, tumor-node-metastases classification, and first-course treatment in patients treated between 2012 and 2015. We compared the patterns of first-line treatment between elderly and non-elderly patients. A total of 1012 patients were diagnosed with squamous cell carcinoma among 1773 patients with penile tumors who registered under topography code C60. The median age at diagnosis was 74years, and 85.9% of patients were aged >60years. The most common pathology was usual-type squamous cell carcinoma (91.9%), followed by verrucous carcinoma (5.0%), sarcomatoid carcinoma (1.1%), papillary carcinoma (0.7%), basaloid carcinoma (0.6%), adenosquamous carcinoma (0.4%), warty carcinoma (0.2%) and mixed carcinoma (0.1%). A total of 61.3% of patients were diagnosed with localized disease. In contrast, the proportions of patients with lymph node and distant metastases were 27.5% and 2.1% at diagnosis, respectively. The proportion of patients who were treated with chemotherapy as the first-course treatment was significantly lower among elderly patients (≥80years) with clinical stageIII (27.6% vs 7.1%, P=0.0312) and clinical stageIV (53.2% vs 14.3%, P=0.0086). Most penile cancer patients in Japan are diagnosed with usual-type squamous cell carcinoma, and those with human papilloma virus-related squamous cell carcinomas are <1%. Chemotherapy for advanced penile cancer is administered less in Japanese elderly (≥80years) patients.

Prevalence of diabetes in Japanese patients with cancer.

Cancer patients with diabetes experience a poorer prognosis, yet the population burden of this multimorbidity remains unknown. This study aimed to estimate the latest incidence and prevalence of cancer with diabetes mellitus in Japan. We used projection of cancer incidence and latest survival data from population‐based cancer registries. The incidence of cancer associated with diabetes was estimated separately for patients with pre‐existing diabetes and those without diabetes, and used to estimate the 5‐year cancer prevalence for those with and without diabetes. The prevalence of pre‐existing diabetes in cancer patients at any cancer site was estimated to be 20.7% (647,160 men and women). Among cancer sites, diabetes prevalence was high in patients with liver and pancreatic cancers in both sexes. In conclusion, our study shows a large burden of diabetes in cancer patients in Japan, which warrants further attention by health practitioners and policy‐makers.

A multicenter retrospective investigation on the efficacy of perioperative oral management in cancer patients.

Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy.The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis.The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated.A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously.Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.

Abstract P2-15-08: Efficacy and possible predictive factors of eribulin in a real-world population of HER-2 negative metastatic breast cancer patients in Japan

Abstract Background Eribulin mesylate, a non-taxane microtubule inhibitor, has unique characteristics that modify the tumor microenvironment by reversing epithelial-mesenchymal transition (EMT) to mesenchymal-epithelial transition (MET). These effects might benefit the efficacy of chemotherapies, particularly those administered after eribulin. In fact, the EMBRACE study demonstrated that eribulin did not prolong progression-free survival (PFS) but rather overall survival (OS) when compared to the treatment of physician’s choice (TPC). However, the effects of eribulin on post-eribulin chemotherapy regimens remain unclear. Thus, this retrospective study aimed to assess PFS, OS, and post progression survival (PPS) of women with HER-2 negative metastatic breast cancer (MBC) as real-world data. In addition, clinical and pathological factors were analyzed as predictive factors for the survival measurements. Furthermore, the effect of eribulin on post-eribulin chemotherapies was also evaluated by assessing PFS of post-eribulin chemotherapy compared with PFS of eribulin and PFS of pre-eribulin chemotherapy. Methods A total of 75 women with HER-2 negative MBC who were treated with eribulin between January 2011 and June 2019 were included in this study. PFS, OS, and PPS were calculated according to the Kaplan-Meier method for each patient. The clinical and pathological factors analyzed in this study were hormone receptors, age, number of prior regimens, metastatic site, number of metastatic sites, and hematologic parameters such as neutrophil (NEU) counts, lymphocyte (LYM) counts, and neutrophil to lymphocyte ratio (NLR). A cox model was used to correlate these factors with survivals. In this study, PFS of the post-eribulin chemotherapy cohort divided by PFS of the eribulin-receiving cohort or PFS of the pre-eribulin chemotherapy cohort was analyzed as a unique parameter of the PFS ratio (PFSr, the former was PFSr A and the latter was PFSr B). A PFS ratio of 1.0 or higher may be the significantly favorable effect of eribulin on post-eribulin chemotherapy. Of a total of 75 patients, 46 and 36 were analyzed for assessing PFSr A and B, respectively, since patients who were not eligible for the calculation of PFSr were excluded. Single and multiple regression analyses were used to evaluate the associated factors with PFSr B. Results The median PFS, OS, and PPS were 3.5 months (95%CI 2.5-4.4), 13.1 (95% CI 9.4-16.7), and 13.1(95%CI 9.4-22.9), respectively. In univariate analysis, an age of 65 or older (p=0.001) and lower NLR (p=0.003) were associated with longer PFS. In multivariate analyses, an age of 65 or older (p=0.041) and lower NLR (p=0.008) were associated with superior PFS. NEU counts lower than 4500 (p=0.0028) and lower NLR (p=0.003) were correlated with longer OS in both univariate and multivariable analyses. There were no correlating factors with PPS. The median PFSr A and B were 0.86 and 0.65, respectively, and the percentages of PFSr A and B were 43% and 33%, respectively. Single and multiple regression analysis each showed that none of the factors are correlated with PFSr B. Conclusion The median PFS and OS in our study were comparable to those reported in the EMBRACE study which were 3.7 and 13.1 months, respectively. Age and NLR were associated with PFS and NEU count and NLR was associated with OS. The correlation of NEU count and NLR with PFS and OS suggests that the effects of eribulin might be diminished by a high inflammatory state but enhanced by higher oncologic immune status. In terms of eribulin’s effect on post-eribulin chemotherapy, no conclusive data were obtained in this study, and a larger number of patients should be analyzed. Citation Format: Sera Satoi, Hiroyuki Takei, Keiko Yanagihara, Tomoko Kurita, Maki Nakai, Meishi Hankyo, Rina Kanamaru, Ai Sato. Efficacy and possible predictive factors of eribulin in a real-world population of HER-2 negative metastatic breast cancer patients in Japan [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-15-08.

Abstract P2-14-06: Systemic therapy for and prognosis of older stage II and III breast cancer patients: Evaluation of data from the Japanese breast cancer registry

Abstract Background: Currently, treatment for older breast cancer patients is largely based on data derived from trials enrolling younger patients; thus, the standard of care for older breast cancer patients remains controversial. Aim: To investigate the clinicopathological characteristics, treatments, and prognosis in older stage II and III breast cancer patients using data from the Japanese Breast Cancer Registry (JBCR). Methods: We reviewed data from the JBCR, a nationwide registry of newly diagnosed and operated primary breast cancer patients in Japan. To clarify those characteristics, we compared clinicopathological characteristics, treatments, and prognosis among three groups: older group, patients aged ≥75 years; young-old group, patients aged 65–74 years; post-menopause group, patients aged 55–64 years. Results: In total, we reviewed 56,093 cases of stage II/III breast cancer diagnosed between 2004 and 2011 (older: n=12,727; young-old: n=17,860; post-menopause: n=25,506). The estrogen receptor (ER) positivity rate was higher (older vs. young-old vs. post-menopause: 73.3% vs. 72.0% vs. 68.0%) and HER2 positivity rate was lower in the older group than in the other two groups (12.9% vs. 16.8% vs. 23.6%) (p&amp;lt;0.001). The following table shows the rate of administration of adjuvant systemic therapy according to the ER and HER2 status. Age (years)≥7565–7455–64p-valueER+Chemotherapy10.042.562.9&amp;lt;0.001Endocrinetherapy83.788.887.7&amp;lt;0.001ER-Chemotherapy33.576.787.7&amp;lt;0.001HER2+Chemotherapy27.474.386.3&amp;lt;0.001Trastuzumab31.659.162.7&amp;lt;0.001 Nearly half of the older patients (48.3%) who received chemotherapy received either cyclophosphamide-methotrexate-fluorouracil or oral fluorouracil. As for hormone therapy, tamoxifen was used more frequently in the older group than in the young-old and post-menopause groups (16.5% vs. 8.6% vs. 7.2%). The following table shows the results of the 5-year overall survival (OS) and breast cancer-specific survival (BCSS) analyses: Conclusions: Chemotherapy was less common in older patients, especially patients with HER2+ or triple negative breast cancer, resulting in worse BCSS. As older patients tend to have several comorbidities, comprehensive geriatric assessment might be helpful in determining systemic therapies for older patients. Age (years)≥7565–7455–64p-valueER+OS/BCSS (%)84.1/94.592.5/96.093.2/94.9&amp;lt;0.001/&amp;lt;0.001HER2+OS/BCSS (%)75.7/87.190.6/93.991.6/93.2&amp;lt;0.001/&amp;lt;0.001Triple negativeOS/BCSS (%)64.9/78.681.8/86.382.6/85.3&amp;lt;0.001/&amp;lt;0.001 Citation Format: Akimitsu Yamada, Masataka Sawaki, Hiraku Kumamaru, Hiroaki Miyata, Kanako Nakayama, Chikako Shimizu, Mika Miyashita, Naoko Honma, Itaru Endo, Naruto Taira, Shigehira Saji. Systemic therapy for and prognosis of older stage II and III breast cancer patients: Evaluation of data from the Japanese breast cancer registry [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-06.

Abstract P6-11-16: Survey on attitude towards treatment recommendations for elderly patients with breast cancer

Abstract Background: With the rapid aging of the society, breast cancer in elderly people is also increasing. Although it is important to avoid unnecessary toxicity to maintain the quality of life of elderly patients, it is suggested that they are undertreated compared to younger counterparts which leads to poorer outcomes. The objective of this study was to assess the practice of the clinical care for elderly breast cancer patients aged 75 or over, and to explore the factors associated with physicians’ attitude regarding treatment recommendations towards elderly breast cancer patients in Japan. Methods: We conducted an online survey towards 1690 Breast Care Specialists belonging to the Japanese Breast Cancer Society. The respondents were asked to complete a questionnaire including (1) sociodemographic background, (2) hypothetical case scenarios in patients with Stage IIB breast cancer, (3) clinical experience of elderly breast cancer patients, (4) Good Death Inventory (GDI), a measure for evaluating good death from the bereaved family member's perspective and (5) belief regarding cancer treatment for elderly breast cancer patients. We used descriptive statistics to summarize respondents' sociodemographic data. Chi-square tests were used to evaluate differences in proportion. Differences in GDI scores were estimated using Mann-Whitney tests. Statistical analyses were performed using SPSS software. Results: 508 (30%) physicians responded to the survey. 353 (69.4%) were male. 464 (91.3%) were breast surgeons and 43 (8.4%) were others, including medical oncology, radiology and general surgery. 46 (9%), 115 (22.6%), 284 (55.9%) and 47 (9.3%) belonged to cancer centers, university hospitals, general hospitals and clinics, respectively. 136 (26.8%) of the physicians responded that they have a specialized department or a team which serve for elderly patients in their institutions, whereas 369 (72.6%) answered there was no such support. In questions based on hypothetical case scenarios, significantly more physicians responded that they would not recommend chemotherapy in a 78 year-old with luminal-type breast cancer, good performance status (PS) and no complications compared to a 55 year-old with the same clinical status (p&amp;lt;0.001). Physicians who would recommend chemotherapy significantly decreased in a clinical scenario of a 78 year-old with the same clinical stage and subtype but with a lower PS and some complications (p&amp;lt;0.001). More physicians recommended chemotherapy in a 78 year-old with HER2 type tumor compared to a patient with luminal type tumor when the PS and complication status were the same (p&amp;lt;0.001). The respondents’ GDI Scores were not related to the treatment recommendations in any clinical scenario. Physicians who treated larger number of outpatients per day and those who had lower proportion of elderly patients in the clinic tended not to recommend chemotherapy for elderly patients with poorer PS and serious complications. Those who believed that “it is a doctor’s responsibility not to pursue aggressive chemotherapy in elderly patients” tended not to recommend chemotherapy in a 78-year-old patient with luminal type breast cancer with good PS and without complication. Conclusions: The attitude towards treatment recommendation on adjuvant chemotherapy in elderly breast cancer patients were related to performance status, complications and subtype of the tumor. Physicians’ experience and belief may also affect their attitude. Citation Format: Kanako Nakayama, Chikako Shimizu, Keiko Iino, Shigeaki Watanuki, Masataka Sawaki. Survey on attitude towards treatment recommendations for elderly patients with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-16.

Venous Thromboembolism in Patents With Lung Cancer.

Lung cancer is the leading cause of death from cancer in Japan. Studies in other countries have reported a venous thromboembolism (VTE) rate of 4%–20% in cancer patients. In this study, we aimed to determine the incidence of VTE in lung cancer patients in Japan and compared the characteristics of patients with and without VTE. In this retrospective cohort study, the clinicopathological characteristics of study patients with and without concomitant VTE were compared. Patients with lung cancer treated at Fukui Prefectural Hospital, Japan from 2008 to 2017. Of the 1471 patients with lung cancer studied, 28 developed VTE. Five patients developed pulmonary thromboembolism (PTE) alone, 9 PTE with concomitant deep vein thrombosis, and 14 deep vein thrombosis alone. Compared with patients in the non-VTE group, the VTE group was significantly younger (mean value ± SD 66.3 ± 10.1 vs. 73.0 ± 10.6 years, p = 0.001), contained significantly more patients with stage IIIb–IV disease (p = 0.002), and had a significantly higher rate of chemotherapy (p < 0.001) and radiation therapy (p = 0.007). There was no significant difference in median survival time from lung cancer diagnosis between the VTE and non-VTE groups. The 1-year mortality rate after VTE diagnosis was 60.7%. Lung cancer was the most frequent cause of death, followed by infection and VTE. Several baseline characteristics differed between patients with and without VTE. The prognosis may worsen after development of VTE, suggesting that lung cancer patients should be carefully monitored for it.

A population-based study of the humanistic burden among cancer patients in Japan

Aims: Understanding the burden of cancer in Japan is becoming increasingly important to address the socio-economic consequences of the disease. This study broadly examined the cancer burden in terms of: Health-Related Quality of Life (HRQoL), work productivity and activity impairment (WPAI), stress-related comorbidities, and indirect costs in patients diagnosed with (i) any type of cancer, (ii) breast cancer, (iii) colorectal cancer, compared to controls without cancer.Materials and methods: This cross-sectional study used data from the 2017 Japan National Health and Wellness Survey (NHWS). Patient outcomes included self-reported stress-related comorbidities, HRQoL assessed by Short Form 12-item Health Survey and EuroQoL 5-dimension scale (EQ-5D), and work productivity and indirect costs assessed by WPAI questionnaire. Multivariate analysis was performed to compare outcomes across groups. An ad-hoc analysis compared respondents currently and currently not receiving prescription medication (Rx).Results: A total of 1,540 patients with any type of cancer, 254 with breast cancer, 144 with colorectal cancer were included in the analyses and compared to 28,070 controls without cancer. After adjusting for potential confounding effects patients with any type of cancer had significantly lower mental component summary scores (45.70 vs. 46.45, p = .003), physical component summary scores (48.95 vs. 50.02, p < .001) and EQ-5D index (0.77 vs. 0.79, p < .001), and significantly increased absenteeism (5.13% vs. 2.68% p < .001) compared to controls. No significant differences were detected for indirect costs. Breast cancer patients had significantly increased odds of anxiety and migraine. Colorectal cancer patients had significantly increased odds of insomnia. Patients currently receiving Rx had significantly lower HRQoL and higher WPAI than both controls and cancer patients not receiving Rx.Conclusions: Japanese cancer patients experience a significantly decreased HRQoL, increased absenteeism and higher odds ratio for stress-related comorbidities. This has implications for future policy making and Health Technology Assessment in Japan.

The health-related quality of life and Economic burden on Cancer Patients in Japan

Abstract Background Information on health-related quality of life (HRQoL) and economic burden are becoming more important in order to select the optimal treatments while considering increasing medical costs. However, limited research focusing on them has been done. We aim to compare HRQoL, work productivity, and estimated economic losses between patients with any types of cancer and non-cancer patients in Japan. Methods Data were obtained from the 2017 Japan National Health and Wellness Survey database including 30,001 participants, a cross-sectional survey representative of the Japanese adult population. Respondents without cancer were identified as the non-cancer group. Mental component summary (MCS) and physical component summary (PCS) of the SF-12v2 were used. The economic losses estimated from annual indirect costs derived from work productivity and activity impairment (WPAI) score and average wage were calculated using the human capital method. Results Cancer patients with who undergo treatment (A: N = 330), not cancer treatment currently (B: N = 1,210) and non-cancer patients (C: N = 28,070) were included in the analysis. Undergo cancer treatment patients had significantly lower compare to other groups on MCS value (43.68 vs. 46.38 vs. 46.55, A vs. B p Conclusion Patients with any types of cancer had higher burden compared to those without in terms of lower HRQoL, higher WPAI, and higher indirect costs. These findings would be useful for the discussion of the value in cancer treatments by multiple perspectives and health technology assessment process.

238P - Elderly patients in the Japanese breast cancer registry

BackgroundAim: To clarify the clinicopathological characters and treatments and prognosis in elderly breast cancer patients using the Japanese Breast Cancer Registry (JBCR) system. MethodsWe reviewed data from JBCR, which is the nation-wide registry of newly diagnosed and operated primary breast cancer patients in Japan. To clarify its characteristics, we compared elderly patients aged 75 and over (elderly) with aged from 65 to 74 (young-old; y-o) and that from 55 to 64 (post-menopausal; p-m), respectively. ResultsIn total 132,240 cases diagnosed between 2004 and 2011 were reviewed (elderly; n=27,385, y-o; n=43,839, p-m; n=61,016). In histology, the proportion of mucinous carcinoma and apocrine carcinoma were higher in elderly (6.1%, 1.8%, y-o; 3.5%, 1.7%, p-m; 1.8%, 1.3%, respectively). Patients with clinical stage II and III were more frequent in elderly (45.1%, y-o; 39.0%, p-m; 39.8%). ER -positive rate was higher (76.8%, y-o; 76.3%, p-m; 72.7%) and HER2-positive rate was lower in elderly (10.5%, y-o; 12.8%, p-m; 18.6%, p<0.001). As for surgery, the rate of breast conserving surgery (BCS) was lower in elderly (46.4%, y-o; 55.0%, p-m; 59.6%), and the rate of no surgery for axilla was higher in elderly (18.4%, y-o; 5.9%, p-m; 4.8%, p<0.001). Irradiation after BCS was performed only in 41.3% of elderly patients, whereas y-o and p-m were 75.9%, 83.0%, respectively. Adjuvant chemotherapy was performed only in 10.8% of elderly patients, y-o and p-m were 31.8%, 46.2%, respectively. Half of elderly patients (49.8%) who underwent chemotherapy were given CMF or oral 5FU. As for hormone therapy, Tamoxifen was used more frequently in elderly (18.1%, y-o; 10.6%, p-m; 9.7%). The 5 years-survival analysis is shown in Table.Table238PTableAge≧7565-7455-64Distant disease-free survival (%)93.194.393.1Overall survival (%)84.393.794.4Breast cancer-specific survival (BCSS) (%)94.296.795.9Other disease death (%)48.035.820.6 ConclusionsElderly patients suffered from more advanced disease at the time of diagnosis. Irradiation after BCS and primary systemic chemotherapy was more frequently omitted in the elderly patients. Overall, BCSS was similar among ages, but the rate of other causes of death was higher in elderly patients. Legal entity responsible for the studyThe authors. FundingJapanese Breast Cancer Society. DisclosureAll authors have declared no conflicts of interest.