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Research Summary

Development of the Japanese Version of the Edmonton Symptom Assessment System – Revised

A revised version of the Edmonton Symptom Assessment System (ESAS-r) is a self-report symptom measurement tool, which includes nine common symptom-related items of advanced cancer: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. We administered the tool to validate and investigate optimal cutoff points for the Japanese version of the ESAS-r in 292 Japanese adult patients with cancer. As for results of the study, the Japanese version of the ESAS-r is a reliable (intraclass correlation coefficient: 0.90) and valid (Cronbach's alpha: 0.87) tool for measuring symptoms, and can accurately represent the severity of many symptoms in Japanese adult patients with cancer (Yokomichi N, et al. J Pain Symptom Manage. 2015; Yamaguchi T, et al. J Pain Symptom Manage. 2015).

Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study.

We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival. After propensity-score weighting, median survival was 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1.01 [95% CI 0.87-1.17]; log-rank p=0.91). Age (pinteraction=0.67), sex (pinteraction=0.26), performance status (pinteraction=0.90), and volume of artificial hydration (pinteraction=0.14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (pinteraction=0.021). CDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialized palliative care services, and could be considered a viable option for palliative care in this setting (Maeda I, et al. Lancet Oncol. 2016).