研究者詳細 - 辻　哲也

論文 - 辻　哲也

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Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey

Nakayama Noriko, Tsuji Tetsuya, Aoyama Makoto, Fujino Takafumi, Liu Meigen

BMC WOMENS HEALTH 20 （ 1 ） 148 2020年07月

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Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members.

Hasegawa T, Sekine R, Akechi T, Osaga S, Tsuji T, Okuyama T, Sakurai H, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M

Journal of pain and symptom management 2020年06月

ISSN 0885-3924

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Subcutaneous lymphatic vessels in the lower extremities: Comparison between photoacoustic lymphangiography and near-infrared fluorescence lymphangiography

Suzuki Y., Kajita H., Konishi N., Oh A., Urano M., Watanabe S., Asao Y., Imanishi N., Tsuji T., Jinzaki M., Aiso S., Kishi K.

Radiology （Radiology） 295 （ 2 ） 469 - 474 2020年05月

ISSN 00338419

© RSNA, 2020. Background: Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose: To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods: In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 3 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results: Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years 6 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels 6 1.2 vs 2.0 vessels 6 1.1, respectively; P , .05) and proximal (mean: 6.5 vessels 6 2.6 vs 2.6 vessels 6 1.6; P , .05) regions of the calf. Conclusion: Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules.

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Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review

Morishita S., Nakano J., Fu J.B., Tsuji T.

Hematology (United Kingdom) （Hematology (United Kingdom)） 25 （ 1 ） 95 - 100 2020年01月

ISSN 10245332

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Many studies have reported that physical exercise can improve the levels of function, quality of life (QoL), and fatigue in patients with hematologic malignancies. However, exercises should be prescribed with caution in patients with thrombocytopenia to prevent exercise-related bleeding. Some studies have suggested threshold platelet counts at which physical exercise can safely be performed. Herein, we review the current literature to determine the platelet count thresholds and types of physical exercise that may be prescribed to reduce the risk of exercise-related bleeding in those with hematological malignancies while undergoing chemotherapy.

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緩和ケア主体の時期のがんリハビリテーション診療

辻哲也

The Japanese Journal of Rehabilitation Medicine （公益社団法人日本リハビリテーション医学会） 57 （ 9 ） 828 - 835 2020年

ISSN 1881-3526

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支持・緩和療法

奥坂拓志, 保田知生, 眞島喜幸, 小川朝生, 余宮きのみ, 辻哲也, 森雅紀, 鈴木賢一, 丹藤雄介, 藤森麻衣子, 坂本はと恵

膵臓（日本膵臓学会） 35 （ 1 ） 79 - 82 2020年

ISSN 0913-0071

癌患者に必要とされる支持・緩和療法は多岐にわたり，その一部については専門学会からのガイドラインも出版されているが，膵癌患者に特に重要と考えられる臨床的疑問については本ガイドラインにおいて指針を提示することが必要との議論がなされ，2016年版より精神心理的苦痛への対応方法，上腹部痛・背部痛に対する治療法，栄養療法，が取り上げられることとなった．2019年版ではさらに，膵癌術後患者に対する運動療法，アドバンス・ケア・プランニング，化学療法における末梢神経障害への対応方法，を新たなCQとして設定し，エビデンスの収集と推奨の提言を行った．また，悪液質を伴う膵癌患者における栄養支持療法，患者向け資材（パンフレット），コミュニケーション・スキル，心理的・社会的・経済的問題に対する支援，患者会，についてコラムで取り上げて情報提供を行うこととした．

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Risk factors of impairment of shoulder function after axillary dissection for breast cancer

Kikuuchi M., Akezaki Y., Nakata E., Yamashita N., Tominaga R., Kurokawa H., Hamada M., Aogi K., Ohsumi S., Tsuji T., Sugihara S.

Supportive Care in Cancer （Supportive Care in Cancer） 2020年

ISSN 09414355

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Objectives: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. Methods: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). Results: Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. Conclusion: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.

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Landscape of education and clinical practice in geriatric oncology: a Japanese nationwide survey

Nishijima Tomohiro F., Tamura Kazuo, Nagashima Fumio, Aiba Keisuke, Saito Mitsue, Saeki Toshiaki, Karasawa Kumiko, Uchitomi Yosuke, Takahashi Takao, Kaibori Masaki, Sakuda Hiromi, Imamura Chiyo, Tsuji Tetsuya

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 49 （ 12 ） 1114 - 1119 2019年12月

ISSN 0368-2811

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Assessment of the Mini-Balance Evaluation Systems Test, Timed Up and Go test, and body sway test between cancer survivors and healthy participants

Morishita S., Hirabayashi R., Tsubaki A., Aoki O., Fu J., Onishi H., Tsuji T.

Clinical Biomechanics （Clinical Biomechanics） 69 28 - 33 2019年10月

ISSN 02680033

© 2019 Elsevier Ltd Background: Cancer survivors experience late and long-term effects of treatment; also, the disease itself might be responsible for persisting functional impairments. The purpose of this study was to investigate muscle strength, balance function using the Mini-Balance Evaluation Systems Test and Timed Up and Go test with single and cognitive dual tasks and body sway in breast cancer survivors and healthy women and non-breast cancer survivors and healthy participants. Methods: Twenty-six cancer survivors and 19 healthy participants were assessed for grip and knee extension strength with the Mini-Balance Evaluation Systems Test, Timed Up and Go, and body sway test performance. Findings: Breast cancer survivors had significantly lower hand grip strength (p < .05) and Mini-Balance Evaluation Systems Test scores than healthy women (p < .05). Additionally, in breast cancer survivors, hand grip strength had a significant relationship with Mini-Balance Evaluation Systems Test and Timed Up and Go scores (p < .05) but had no relationship with the total center of pressure length. Hand grip strength and Mini-Balance Evaluation Systems Test scores were not significantly different in non-breast cancer survivors and healthy participants. In non-breast cancer survivors, knee extension strength had a significant relationship with the Timed Up and Go scores (p < .05). Interpretation: The relationship between muscle strength and balance function may be characterized by the different diagnoses in cancer survivors. The current findings showed the changes in balance function and muscle strength among cancer survivors.

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A randomized phase II study of nutritional and exercise treatment for elderly patients with advanced non-small cell lung or pancreatic cancer: The NEXTAC-TWO study protocol

Miura S., Naito T., Mitsunaga S., Omae K., Mori K., Inano T., Yamaguchi T., Tatematsu N., Okayama T., Morikawa A., Mouri T., Tanaka H., Kimura M., Imai H., Mizukami T., Imoto A., Kondoh C., Shiotsu S., Okuyama H., Ueno M., Takahashi T., Tsuji T., Aragane H., Inui A., Higashiguchi T., Takayama K.

BMC Cancer （BMC Cancer） 19 （ 1 ） 528 2019年05月

ISSN 1471-2407

© 2019 The Author(s). Background: Most advanced elderly cancer patients experience fatigue, anorexia, and declining physical function due to cancer cachexia, for which effective interventions have not been established. We performed a phase I study of a new nonpharmacological multimodal intervention called the nutritional and exercise treatment for advanced cancer (NEXTAC) program and reported the excellent feasibility of and compliance with this program in elderly patients with advanced cancer who were at risk for cancer cachexia. We report here the background, hypothesis, and design of the next-step multicenter, randomized phase II study to evaluate the efficacy of the program, the NEXTAC-TWO study. Methods: Patients with chemo-naïve advanced non-small cell lung cancer or pancreatic cancer, age ≥ 70 years, performance status ≤2, with adequate organ function and without disability according to the modified Katz index will be eligible. In total, 130 participants will be recruited from 15 Japanese institutions and will be randomized into either the intervention group or a control group. Computer-generated random numbers are allocated to each participant. Stratification factors include performance status (0 to 1 vs. 2), site of primary cancer (lung vs. pancreas), stage (III vs. IV), and type of chemotherapy (cytotoxic vs. others). Interventions and assessment will be performed 4 times every 4 ± 2 weeks from the date of randomization. Interventions will consist of nutritional counseling, nutritional supplements (rich in branched-chain amino acids), and a home-based exercise program. The exercise program will include low-intensity daily muscle training and lifestyle education to promote physical activity. The primary endpoint is disability-free survival. It is defined as the period from the date of randomization to the date of developing disability or death due to any cause. This trial also plans to evaluate the improvements in nutritional status, physical condition, quality of life, activities of daily living, overall survival, and safety as secondary endpoints. Enrollment began in August 2017. The study results will demonstrate the efficacy of multimodal interventions for elderly cancer patients and their application for the maintenance of physical and nutritional conditions in patients with cancer cachexia. This work is supported by a grant-in-aid from the Japan Agency for Medical Research and Development. Discussion: This is the first randomized trial to evaluate the efficacy and safety of a multimodal intervention specific for elderly patients with advanced cancer.

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Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation

Ishikawa A., Otaka Y., Kamisako M., Suzuki T., Miyata C., Tsuji T., Matsumoto H., Kato J., Mori T., Okamoto S., Liu M.

Supportive Care in Cancer （Supportive Care in Cancer） 27 （ 5 ） 1793 - 1800 2019年05月

ISSN 09414355

© 2018, The Author(s). Purpose: The aim of this study is to clarify the factors affecting physical function after allogeneic hematopoietic stem cell transplantation (HSCT). Methods: We retrospectively analyzed 88 patients (median age, 44.5 years) who received allogeneic HSCT. Leg extension torque and peak oxygen consumption (VO 2 ) were evaluated before and after HSCT. Patient factors (age, sex, underlying diseases, hemoglobin, serum albumin, and Karnofsky performance status score before transplant) and transplant factors (conditioning regimen, days to neutrophil engraftment, grades of acute graft-versus-host disease [GVHD], infections, and the interval between pre- and post-evaluation) were collected via chart review, and were used for correlational and comparison analyses in order to identify the variables associated with reduced post-HSCT leg extension torque and peak VO 2 . Stepwise multiple regression analyses for post-HSCT leg extension torque and post-HSCT peak VO 2 were performed using age, sex, and the related variables with a p value < 0.2 in the correlational and comparison analyses. Results: Leg extension torque and peak VO 2 were significantly reduced after HSCT (p < 0.001). Pre-HSCT leg extension torque, grades of acute GVHD, age, and the interval between pre- and post-evaluation were identified as significant factors associated with reduced post-HSCT leg extension torque. However, none of these factors were significantly associated with reduced post-HSCT peak VO 2 , and only its pre-transplant value was identified as a significant factor. Conclusions: These findings suggest that improvements in muscle strength and cardiopulmonary fitness before HSCT are crucial for maintaining post-treatment physical function, especially in elderly individuals with acute GVHD requiring a long-term stay in a protective environment.

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Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer

Naito T., Mitsunaga S., Miura S., Tatematsu N., Inano T., Mouri T., Tsuji T., Higashiguchi T., Inui A., Okayama T., Yamaguchi T., Morikawa A., Mori N., Takahashi T., Strasser F., Omae K., Mori K., Takayama K.

Journal of Cachexia, Sarcopenia and Muscle （Journal of Cachexia, Sarcopenia and Muscle） 10 （ 1 ） 73 - 83 2019年02月

ISSN 21905991

© 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders Background: Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods: This was a multicentre prospective single-arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first-line chemotherapy for newly diagnosed, advanced pancreatic, or non-small-cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder ® , Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home-based low-intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched-chain amino acids (Inner Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. Results: The median patient age was 75 years (range, 70–84). Twelve patients (40%) were cachectic at baseline. Twenty-nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions: The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.

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Risk Factors for Lymphedema in Breast Cancer Survivors Following Axillary Lymph Node Dissection

Akezaki Yoshiteru, Sugihara Shinsuke, Tominaga Ritsuko, Kikuuchi Masato, Kurokawa Hideaki, Hamada Makiko, Aogi Kenjiro, Ohsumi Shozo, Tsuji Tetsuya, Kawamura Susumu

Progress in Rehabilitation Medicine （公益社団法人日本リハビリテーション医学会） 4 （ 0 ） 20190021 2019年

Objective: The aim of the current study was to assess the risk factors for developing lymphedema following breast cancer treatment. Methods: The subjects of this study were 238 consecutive patients who underwent axillary lymph node dissection for breast cancer at Shikoku Cancer Center. The study variables were the occurrence of lymphedema, the body mass index, the follow-up period, the drain removal time, the level of lymph node dissection, the presence or absence of co-resident household members, radiation therapy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Results: We observed lymphedema in 23.9% of patients after axillary lymph node dissection for breast cancer. Neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide increased the risk of developing lymphedema (P <0.05). Conclusions: Those patients treated with neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide should be observed closely after axillary lymph node dissection, and appropriate intervention should be considered from an early stage.

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Neuromuscular electrical stimulation-enhanced rehabilitation is associated with not only motor but also somatosensory cortical plasticity in chronic stroke patients: an interventional study

Tashiro S., Mizuno K., Kawakami M., Takahashi O., Nakamura T., Suda M., Haruyama K., Otaka Y., Tsuji T., Liu M.

Therapeutic Advances in Chronic Disease （Therapeutic Advances in Chronic Disease） 10 2040622319889259 2019年

ISSN 20406223

© The Author(s), 2019. Background: Somatosensory function has been frequently overlooked in clinics and research in the field of chronic stroke. The effects of neurorehabilitation interventions on sensory processing have still to be investigated using electrophysiological means. This study investigated the effect of hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy utilizing closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES), on sensory changes and cortical plasticity among patients with chronic stroke. Methods: This study was a prespecified analysis of 23 participants involved in an ongoing large interventional study. Patients with severe upper limb hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS therapy, where daily treatment consisted of 8 h of NMES combined with wrist splinting, 90 min of comprehensive occupational therapy, and the practice of bimanual activities of daily living. Somatosensory evoked potentials (SEPs) and functional sensory assessments, including the Semmes–Weinstein monofilament test (SWMT) and thumb localizing test (TLT), were compared pre and post-treatment. Results: While no significant recovery of tactile sensation was observed, significant improvements in proprioception and motor function were induced. The number of cortical peaks significantly increased in the median nerve, but not in the tibial nerve. A total of 9 out of 11 participants who initially lacked certain peaks responded to treatment. Further analysis revealed a significant improvement in latency and amplitude of SEP peaks. Conclusions: Our results suggest that NMES-based neurorehabilitation induces certain plastic changes in the primary sensory cortex and in cortices associated with sensorimotor processing in people with chronic stroke sequelae, which may explain the observed improvements in proprioception.

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Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study

Shimoda Kaori, Imai Hisao, Tsuji Tetsuya, Tsuchiya Kenji, Tajima Hiroshi, Kanemaki Hatsumi, Tozato Fusae

Journal of Physical Therapy Science （理学療法科学学会） 31 （ 10 ） 795 - 801 2019年

ISSN 0915-5287

[Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer is futile. We determined factors affecting the performance of activities of daily living in patients with advanced cancer based on age, gender, marital status, living arrangement, rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the performance of activities of daily living. Of the 120 adult patients with cancer who underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10 items, and reviewed the clinical characteristics from the medical records of 48 patients who completed supportive or palliative rehabilitation according to Dietz and showed an increased or maintained total Barthel Index score at final evaluation. [Results] The median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that the increase of total Barthel Index score was positively associated with rehabilitation intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277). [Conclusion] Adequate rehabilitation positively affects performance of activities of daily living, especially in patients with advanced cancer who lost their grooming ability at the onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with advanced cancer.

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Differences in Balance Function Between Cancer Survivors and Healthy Subjects: A Pilot Study

Morishita S., Mitobe Y., Tsubaki A., Aoki O., Fu J., Onishi H., Tsuji T.

Integrative cancer therapies （Integrative cancer therapies） 17 （ 4 ） 1144 - 1149 2018年12月

ISSN 15347354

Older adults who have survived cancer experience significantly more falls compared with healthy adults. Adult cancer survivors may also have a lower balance function than healthy adults. We examined muscle strength and balance function among 19 cancer survivors and 14 healthy subjects. The mean age of the cancer survivors was 51.5 ± 11.2 years; 6 men and 13 women. Cancer diagnoses included breast cancer, retroperitoneal sarcoma, acute leukemia, lung cancer, colorectal cancer, thyroid cancer, Ewing's sarcoma, and tongue cancer. The mean age of healthy subjects was 47.4 ± 14 years; 3 men, 11 women. Muscle strength was assessed using hand grip and knee extensor strength tests. Balance function was evaluated using the Timed Up and Go (TUG) test, and body sway was tested using a force platform. No significant differences were found with respect to right and left grip strength or right and left knee extension strength between the 2 groups. A significantly higher TUG time was observed in cancer survivors than in healthy subjects ( P < .05). With eyes open, the area of the center of pressure was significantly larger in cancer survivors than in healthy subjects ( P < .05). Similarly, the length per area was significantly lower both with eyes open and closed for cancer survivors than for healthy subjects ( P < .05). TUG was significantly correlated with muscle strength in both groups ( P < .05). However, no body sway parameters were related to muscle strength in either group. Cancer survivors had lower balance function that might not have been related to muscle strength. Cancer survivors should be evaluated for balance function as there is a potential for impairment. The findings of this study will be relevant for planning the prevention of falls for cancer survivors.

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悪液質高リスクの高齢進行がん患者に対する在宅ベースの下肢筋力トレーニングプログラムの開発　NEXTAC-ONE試験の運動介入の詳細

立松典篤, 岡山太郎, 辻哲也, 岩村明, 田沼明, 内藤立暁, 光永修一, 三浦理, 大前勝弘, 盛啓太, 高山浩一

Palliative Care Research （(NPO)日本緩和医療学会） 13 （ 4 ） 373 - 381 2018年12月

【目的】悪液質リスクの高い高齢進行がん患者に対して、初回化学療法導入時より栄養と運動を組み合わせたマルチモーダルな介入プログラムを開発した。本研究の目的は、その中の下肢筋力トレーニングの詳細と安全性および忍容性を報告することである。【方法】対象は、初回化学療法導入予定の70歳以上の進行非小細胞肺がんおよび進行膵がん患者30例とした。下肢筋力トレーニングは約8週間の在宅ベースプログラムとし、対象者別にトレーニング内容および負荷量を設定した。【結果】介入期間中の下肢筋力トレーニングの実施割合は91(69〜95)%であった。治療継続や日常生活に影響を及ぼすような有害事象発生はなく、介入前後で身体機能や活動量の有意な低下は認められなかった。【結論】悪液質リスクの高い高齢進行がん患者において、われわれが開発した下肢筋力トレーニングは高い実施割合を有し、身体機能や身体活動量の維持に寄与した可能性が示唆された。(著者抄録)

肺がん患者が自宅復帰に至るまでの心理的適応

下田佳央莉, 外里冨佐江, 山谷礼輝, 土屋謙仕, 辻哲也

ぐんま作業療法研究（(一社)群馬県作業療法士会） 20 23 - 28 2018年08月

ISSN 1344-4344

進行がん患者がdistress:苦痛を抱える可能性は高いが、その適切な介入法は確立していない。著者らは肺がん患者の自宅復帰支援を多職種で行う機会を得た。その結果、対象者は自身の身体機能の低下や疼痛に影響を受けながらも、日常生活動作能力を向上させると共に、distressの症状を軽減させた。我々は、(1)正のフィードバックを行い対象者の自尊心を保持する、(2)対象者や家族のニーズを聴取し、目標に向け多職種で協働する、(3)外泊訓練を実施するなどの取り組みを行った。本介入は、心身に配慮した多職種でのリハビリテーションは、対象者の自宅復帰に至るまでの再適応の心理的過程である、心理的適応を促進させる可能性を示した。(著者抄録)

Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects

Morishita S., Tsubaki A., Fu J., Mitobe Y., Onishi H., Tsuji T.

European Journal of Cancer Care （European Journal of Cancer Care） 27 （ 4 ） 2018年07月

研究論文（学術雑誌）, 共著, 査読有り, ISSN 09615423

© 2018 John Wiley & Sons Ltd We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p <.05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p <.05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p <.05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors.

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A randomized phase II study of the nutritional and exercise treatment for the elderly patients with advanced non-small cell lung or pancreatic cancer: The NEXTAC-TWO study.

Miura Satoru, Naito Tateaki, Mitsunaga Shuichi, Omae Katsuhiro, Mori Keita, Inano Toshimi, Yamaguchi Teiko, Mori Naoharu, Tatematsu Noriatsu, Okayama Taro, Morikawa Ayumu, Mouri Takako, Tsuji Tetsuya, Aragane Hideki, Inui Akio, Higashiguchi Takashi, Takayama Koichi

JOURNAL OF CLINICAL ONCOLOGY 36 （ 15 ） 2018年05月

ISSN 0732-183X

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