Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Feb 2007
[Participation in the global study. Activities and issues from the bedside].
Global study is becoming popular in the field of the anti-cancer drug development in Japan as well as in the US and European countries. There are many issues to be solved around the bedside and equipping the infrastructure is most important. Early drug development is also important,and we are maintaining the quality and speed in the phase I studies.
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Gan To Kagaku Ryoho · Feb 2007
[Operational aspect of participation in the multi-national clinical trials from the foreign pharmaceutical company's standpoint].
As a means to reduce the delay with the West, the enhanced use of multi-national clinical trials is expected. It is necessary to improve the presence of Japan as a development base by making the best use of the quality of the clinical trials and becoming more competitive in terms of the speed and the cost as compared with other Asian countries. ⋯ The elimination of the difference between the domestic and international regulations is expected of the regulator. Finally, the revision of medical institutions by the government would contribute improvements in the current situation where staff are too busy to conduct clinical trials.
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Rhabdomyosarcoma (RMS) is the most common type of soft-tissue sarcoma in childhood. In Europe and the United States, survival rates of RMS patients, especially those with local or regional RMS, have dramatically improved from around 25% in 1970 to over 70% in 2001 as a result of the introduction of multimodality therapy and cooperative group trials. ⋯ An analysis of registration data from the Japanese Society for Pediatric Surgery as well as our recent retrospective study indicates that the survival rates of each risk group are all lower than those in the US or Europe, even in the "low-risk" group. We have recently established the Japan Rhabdomyosarcoma Study Group (JRSG) and continued several studies in each risk group to improve the outcome and to establish a standard therapy in Japan.
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Gan To Kagaku Ryoho · Dec 2006
[Palliative care team support services by the hospital for home palliation].
At Osaka National Hospital, we opened a palliative care team (PCT) since July 2004. The PCT advises the symptom management of cancer patients and supports patients' decision making. By March 2006, 355 consecutive cancer patients referred to the PCT, including 221 patients with psychiatric symptoms. ⋯ The reasons for this prolongation are that psychiatric symptoms (especially delirium) are often overlooked, and that home doctors and visiting nurses often hesitate to take on the home medical care because of unfamiliarity with them. The management of psychiatric symptoms at home is important for appropriate end-of-life care. The PCT and regional doctors have to work closely in cooperating with the successive palliation when the patient is transformed to home medical care.
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Gan To Kagaku Ryoho · Dec 2006
[Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints].
In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice. (5) To deliberate the difference between ethical and legal judgment, an interdisciplinary approach should be carried out. (6) To achieve consensus among the people, the importance of an Advanced-Directive should prevail widely.