Palliative care
The evaluation of the methodological quality of clinical practice guidelines on palliative care for cancer patients
in Japan
- Author(s)：
- Nobuhisa Nakajima1
- Affiliation(s)：
- 1Division of community medicine and international medicine, Hospital, University of the Ryukyus
Background:
Recently, many academic societies have actively developed clinical practice guidelines (CPGs). However, some variation exists in the development process as well as the quality of product.
The Japan Council for Quality Health Care (JQ) manages CPGs in Japan. JQ evaluated the quality of 519 CPGs (87 for cancer, 432 for non-cancer) published from 2011 to 2017 using AGREE II.
As a result, the quality of cancer-related CPGs was higher than that of non-cancer CPGs. According to the evaluation of Domain3 (Rigor of Development) of AGREE II, 10 CPGs had a score >80 among cancer-related CPGs and five of them were on palliative care published by Japanese Society for Palliative Medicine (JSPM).
Purpose:
JSPM initiated the development of CPGs in 2002 and currently develop and revise 7 CPGs. Four years ago, the guideline committee was revamped with the aim of unifying each CPG subcommittee and standardizing the development process based on GRADE system.
This study aimed to analyze the development process of JSPM-CPGs based on the results of evaluation by JQ and to consider the further improvement of them.
Methods:
(1) We compared the scores of Domain 1-7 of AGREE II for 4 CPGs published or revised by JSPM from 2011 to 2017 with the scores of cancer-related CPGs.
(2) We performed a self-assessment for each item in Domain 3 referring the development process in each CPG. Next, we compared the score of each item with the score of cancer-related CPGs, and then extracted the items that required improvement.
Results:
The scores of Domain 1-7 in JSPM-CPGs were higher than that of cancer-related CPGs, but the difference was small in Domain 5 (applicability: 53-61 vs 48). In Domain 3, item7-9,11 were extracted as the items with very high score.
Conclusions:
We confirmed the high quality of JSPM-CPGs. Improving the quality of the items in Domain 3 and increasing the maturity of the development process of CPGs will lead to further improvement in the quality of CPGs on palliative care.
Effect of paracentesis on the survival of patients with terminal cancer and ascites
- Author(s)：
-
Ken Masuda1, Hiroto Ishiki1, Naosuke Yokomichi2, Takuhiro Yamaguchi3, Tetsuya Ito4, Hana Takatsu5, Koji Amano1,
Shuji Hiramoto6, Toshihiro Yamauchi2, Takashi Kawaguchi7, Masanori Mori2, Yosuke Matsuda8, Takashi Yamaguchi5 - Affiliation(s)：
- 1National Cancer Center Hospital, 2Seirei Mikatahara General Hospital,3Biostatistics, school of medicine, Tohoku University,4Japanese Red Cross Medical Center,5Konan Medical Center,6Mitsubishi Kyoto Hospital,7Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences,8St. Luke's International Hospital
Background: Malignant ascites (MA) is associated with progressive deterioration in quality of life and poor prognosis of patients with cancer. Paracentesis is among the most widely utilised treatments for MA. However, reports on the usefulness of paracentesis in patients with MA are limited. Thus, this study aimed to investigate whether paracentesis affects the duration of survival in such patients.
Methods: We performed a post-hoc analysis of a prospective multicentre observational study that investigated the dying process and end-of-life care in patients with terminal cancer, who were admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used the inverse probability of treatment weighting (IPTW) method to control for baseline covariates between the two groups.
Results: Among the 1,896 patients, who were initially enrolled, 568 with ascites were included in the study cohort. Eighty-five (15·0%) patients underwent paracentesis. The most common primary tumour site was the pancreas (51·9%, n=295), followed by the gastrointestinal tract (22·7%, n=129). The non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16-25) and 12 days (95% CI: 11-13) in the paracentesis and non-paracentesis groups, respectively (hazard ratio [HR]: 0·69, [95% CI: 0·54-0·88]; p=0·003). The IPTW-adjusted median durations of survival were 22 days (95% CI: 16-25) and 16 days (95% CI: 12-22) in the paracentesis and non-paracentesis groups, respectively (HR: 0·89, 95% CI: 0·64-1·24; p=0·492). There were no serious adverse events in the paracentesis group.
Conclusions: Paracentesis does not negatively affect the survival of patients with cancer and MA; hence, it can be used as a standard treatment in palliative care settings.
