Published papers

Objective: This study aims to ascertain the incidence and association of falls and physical inactivity in patients with gastrointestinal cancer and hand-foot syndrome (HFS) after receiving chemotherapy or targeted therapy. Methods: The present cross-sectional study was conducted on 50 outpatients with HFS of Grade 1 or above, according to the National Cancer Institute Common Terminology Criteria for Adverse Events, following the receipt of chemotherapy or targeted therapy for gastrointestinal cancer in Japan between November 2016 and February 2017. For measurement, Dermatology Life Quality Index (DLQI) and the International Physical Activity Questionnaire were used. Data were analyzed by logistic regression analysis. Results: Of the participants, 18% experienced falls and 60% reported physical inactivity. Multivariate logistic regression revealed that the DLQI treatment domain score was the only factor associated with falls (odds ratio [OR] =8.01, 95% confidence interval [CI] =1.27-50.63, P = 0.027). Physical inactivity was associated with DLQI symptom and feeling domain scores (OR = 5.54, 95% CI = 1.26-24.33, P = 0.023) and the with-oxaliplatin or paclitaxel regimen (OR = 3.71, 95% CI = 1.06-13.03, P = 0.041). Conclusions: The results of the present study suggest patients should be informed that HFS is a risk factor for physical inactivity and falls.

Purpose: Adherence to medication is the most important challenge facing patients receiving oral anticancer treatment. This study aimed to evaluate the effects of a patient-centred medication self-management support programme in patients with metastatic breast cancer undergoing oral anticancer treatment. Methods: This trial was a two-phased mixed-method randomised controlled study. Eligible participants were 155 patients with metastatic breast cancer newly prescribed an oral chemotherapy or targeted therapy agent. The intervention group received the patient-centred medication self-management support programme conducted by trained nurses. Primary outcome was adherence to medication at three months after the commencement of treatment, calculated by medication possession ratio (MPR). Secondary outcomes included self-efficacy, functional assessment, psychological distress, symptom severity and symptom interference, and patient satisfaction. After the completion of the intervention study, focus group interviews were conducted among intervention nurses. Results: Both intervention and control groups maintained more than 90% of MPR and no significant difference was observed in the primary outcome. Regarding secondary outcomes, only general self-efficacy was significantly different in the two groups. In the qualitative study, the intervention nurses perceived improvement in the patients’ self-efficacy, ability to anticipate the impact of treatment and adjust to life, and avoidance of loneliness. Conclusions: A significant effect of the programme was not found in the program because the adherence rate was high in both groups. Improvement in the patients’ self-efficacy was observed both quantitatively and qualitatively. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000016597. (27 February 2015).

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of anticancer drugs that causes muscle weakness in the cancer patients, causing them to fall. Therefore, we constructed "FD-AWARE", a system to understand the users' fall context and users' CIPN symptoms as the first step in preventing these falls. This system can collect the various sensor data from the iPhone and the Apple Watch, self-reported fall information data, self-reported user status data of CIPN symptoms, and their physical condition. We conducted a 2-week in-the-wild experiment with 8 patients who were actually suffering from CIPN. We constructed the machine learning models for estimating the users' status of CIPN symptoms and successfully achieved high accuracy of performance for several estimating models.

This study aimed to evaluate the psychometric properties of the Japanese version of the Cancer Survivors' Unmet Needs (CaSUN-J) scale among cancer survivors in Japan. Methods: The CaSUN-J was developed using standardized translation methodology. Content validity was evaluated by a group of experts, and a pilot test was conducted with a convenience sample of 10 cancer patients. A total of 183 Japanese cancer survivors completed the CaSUN-J. The internal consistency of the scale was examined with Cronbach's . Construct validity was analyzed using correlations with the physical effects, quality of life (QoL), and age. To assess the factorial validity of the CaSUN-J, confirmatory factor analysis (CFA) was performed. Results: The CaSUN-J indicated good readability and high content validity for use as an assessment tool among Japanese cancer survivors. All Cronbach's coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores, as well as poorer QoL scores and younger patients, were significantly positively associated with higher levels of needs. CFA indicated that the five-factor structure of the CaSUN-J was a good fit to the data. Conclusions: The CaSUN-J can serve as a valid and reliable tool to evaluate unmet needs among Japanese cancer survivors.

Objective: We investigated the incidence of falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Additionally, we examined whether taxane-induced peripheral neuropathy was associated with the patients' falls and functional impairments. Methods: We conducted a cross-sectional study including 88 patients with breast cancer who received taxane-based chemotherapy and were recognized as having peripheral neuropathy symptoms (Common Terminology Criteria for Adverse Events Grade ≥1). Patients completed the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity questionnaire for neuropathy and described falls from the onset of the taxane-based chemotherapy to the time of the survey. Functional impairments were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Data were analyzed using descriptive statistics and logistic regression. Results: Of the participants, 40.9% experienced falls and 38.4% reported functional impairments. Most falls occurred on flat ground. Bone fracture due to falls was observed in 11.4% of the participants. Logistic regression revealed that CIPN was not significantly associated with the reported incidence of falls. However, it was significantly associated with functional impairments (odds ratio, 6.415; 95% confidence interval: 1.271-32.379; P = 0.024). Conclusions: CIPN was associated with functional impairments, but not with the incidence of falls. Patients should be informed prior to the onset of anticancer therapy that CIPN is a risk factor for functional impairments.

Objective The objective of this study was to understand how reproductive-age women with breast cancer make fertility-related decisions. Methods Using grounded theory methodology, we collected data from 11 reproductive-age women with breast cancer between March and August 2016. Verbatim transcriptions were analyzed using constant comparative analysis and open, axial, and selective coding. Results “Fertility Decision-Making under Certainty and Uncertainty” emerged as a core category. Fertility decision-making started with the participants’ “values and preferences” about having a child. In making a decision, there were certainty (“Information” and “Emotional support”) and uncertainty (“Time constraints,” “Recurrent risk,” “Labeling,” and “Unmet needs”) factors. Participants had more uncertainty factors than certainty factors, and healthcare professionals’ services accounted for one of the uncertainty factors. Conclusions After fertility preservation counseling, women with cancer made difficult decisions in stressful situations without sufficient healthcare information and support. Tailored information should be provided to individual women in collaboration between oncology and reproductive health professionals.

本研究は、若年乳がん女性の治療と妊孕性に対する意思決定支援について、看護師がどのように認識し、実践しているのかを明らかにするために、フォーカスグループと内容分析による質的研究を行った。研究参加者は、若年乳がん患者に携わる専門看護師と認定看護師15名であった。結果として、＜不確かなライフプランの支援＞がコアカテゴリーとして導かれ、3つのカテゴリー〈不確かな将来を歩むための準備〉〈ライフプランの不確かさに伴う葛藤への支援〉〈女性の決断に沿った最善のケア〉が含まれた。看護師は、若年女性ががん治療と妊孕性の課題に伴う葛藤から納得や折り合いをつけたライフプランを支援し、そして女性が決断した不確かな道に歩み出すことを支え、最善を尽くすことの重要性を認識し、実践していた。さらに、看護師は、女性の真の願いを叶えるために組織を超えた多職種の連携、協働や最善のケアを提供することの重要性を認識していた。

Background: While community-wide interventions to promote physical activity have been encouraged in older adults, evidence of their effectiveness remains limited. We conducted a qualitative study among older adults participating in regular group exercise to understand their perceptions of the physical, mental, and social changes they underwent as a result of the physical activity. Methods: We conducted a qualitative study with purposeful sampling to explore the experiences of older adults who participated in regular group exercise as part of a community-wide physical activity intervention. Four focus group interviews were conducted between April and June of 2016 at community halls in Fujisawa City. The participants in the focus group interviews were 26 older adults with a mean age of 74.69 years (range: 66-86). The interviews were analysed using the constant comparative method in the grounded theory approach. We used qualitative research software NVivo10® to track the coding and manage the data. Results: The finding 'regular group exercise contributes to balanced health in older adults' emerged as an overarching theme with seven categories (regular group exercise, functional health, active mind, enjoyment, social connectedness, mutual support, and expanding communities). Although the participants perceived that they were aging physically and cognitively, the regular group exercise helped them to improve or maintain their functional health and enjoy their lives. They felt socially connected and experienced a sense of security in the community through caring for others and supporting each other. As the older adults began to seek value beyond individuals, they gradually expanded their communities beyond geographical and generational boundaries. Conclusions: The participants achieved balanced health in the physical, mental, and social domains through regular group exercise as part of a community-wide physical activity intervention and contributed to expanding communities through social connectedness and mutual support. Health promotion through physical activity is being increasingly emphasized. The study results can help to develop effective physical activity programs for older adults in the community.

Upon publication, the below errors were noticed in the original version of the article [1]. 1) In the title of the article, 'randomised' should be spelt 'randomized' 2) i) In Table 2, 'MMAS-8' should instead read 'cMMAS-8' ii) In Table 2, the following sentence should be included as a footnote: "Use of the cMMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772." iii) In Table 2, there should be check marks under the 'Baseline', '2 months', and '3 months' columns in the PDF as per the HTML 3) In the Acknowledgements, the following sentence should be included as the second paragraph: "Use of the cMMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772." 4) In citation 42, 'Morisky DE, Green LW, Levine DM. Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence and Long-Term Predictive Validity of Blood Pressure Control. Med Care. 196:24:67-74' should read: A. Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive Validity of a Medication Adherence Measure for Hypertension Control. Journal of Clinical Hypertension 2008; 10(5):348-354. B. Krousel-Wood MA, Islam T, Webber LS, Re RS, Morisky DE, Muntner P. New Medication Adherence Scale Versus Pharmacy Fill Rates in Seniors With Hypertension. Am J Manag Care 2009; 15(1):59-66. C. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: Final response. J Clin Epidemio 2011; 64:258-263. PMID: 21144706.

Nurses are critical to the physical management and psychological support of patients undergoing chemotherapy, which is a vulnerable time for many. This article presents the results of a qualitative study intended to explore the experience of Japanese patients with breast cancer during chemotherapy, including the finding that participants created personal safety nets in physical, emotional, and social contexts that helped them to gain confidence in their ability to exert control over their lives. Understanding each patient’s personal safety net allows nurses to support their patients in maintaining and improving their function and well-being. At a Glance • Patients with cancer create personal safety nets in physical, emotional, and social contexts during chemotherapy. • Nurses can reduce patients’ distress, strengthen their safety nets, and empower them to lead meaningful lives. • Nursing care should serve as a safety net for patients undergoing chemotherapy and promote the feeling of safety.

Personalized medicine, the tailoring of prevention and treatment, is the future of routine clinical practice. This approach has started to appear in genetic testing for predisposition to hereditary breast and ovarian cancer (HBOC). We explored how breast-care providers perceived HBOC risk management, using grounded theory. This study found that the frontline healthcare providers perceived HBOC risk management as still being neglected in breast cancer care. Emerging challenges included treatment priority, hesitancy to deal with sensitive issues, easily missed risks, genetic data not being shared among multidisciplinary professionals, and patients being lost to follow-up. Oncology nurses are ideally placed to facilitate communication and utilization of genetic information among multidisciplinary professionals. Specialized outpatient clinics need to be established to follow up individuals at high risk. There is a need to create a system to meet the future demands of personalized medicine in nursing practice. © 2013 Wiley Publishing Asia Pty Ltd.

Lippincott Williams & Wilkins.Background: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. Objective: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. Methods: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. Results: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. Conclusions: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. Implications for practice: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care. Copyright © 2014 Wolters Kluwer Health