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Prospective phase II study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly patients with gastric cancer

Gastric Cancer, 2018, Vol.21(2), pp.353-359 [Peer Reviewed Journal]

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  • Title:
    Prospective phase II study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly patients with gastric cancer
  • Author: Miki, Yuichiro ; Makuuchi, Rie ; Honda, Shinsaku ; Tokunaga, Masanori ; Tanizawa, Yutaka ; Bando, Etsuro ; Kawamura, Taiichi ; Yurikusa, Takashi ; Tanuma, Akira ; Terashima, Masanori
  • Found In: Gastric Cancer, 2018, Vol.21(2), pp.353-359 [Peer Reviewed Journal]
  • Subjects: Gastric cancer ; Elderly patients ; Pneumonia
  • Language: English
  • Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s10120-017-0736-3 Byline: Yuichiro Miki (1,2), Rie Makuuchi (1), Shinsaku Honda (1), Masanori Tokunaga (1), Yutaka Tanizawa (1), Etsuro Bando (1), Taiichi Kawamura (1), Takashi Yurikusa (3), Akira Tanuma (4), Masanori Terashima (1) Keywords: Gastric cancer; Elderly patients; Pneumonia Abstract: Background Aging partly impairs swallowing function, which is considered a risk factor for postoperative pneumonia (PP). We evaluated the efficacy of a new team-based strategy to reduce the incidence of PP in elderly patients with gastric cancer. Methods This single-center, prospective phase II study included elderly patients (a[yen]75 years old) with gastric cancer undergoing gastric surgery. The primary endpoint was the incidence of Clavien-Dindo grade II or higher PP. Patients were initially screened using three swallowing function screening tests: a symptom questionnaire, the modified water swallow test (MSWT), and the repetitive saliva swallowing test (RSST). All patients were provided standard preoperative oral checks and care and simple neck muscle training. For patients who screened positive, a videofluorographic swallowing study was performed if an abnormality was found, the patient was given intensive swallowing rehabilitation both pre- and postoperatively. Results Of 86 eligible patients enrolled, PP developed in 3 (3.5%). The 60% confidence interval of 1.8--6.3% had an upper limit below the prespecified threshold of 7.8%. Positive screening results were found for 19 patients (22.1%) on the symptom questionnaire, 3 (3.5%) on the MSWT, and 1 (1.2%) on the RSST. PP was not observed in any patients who screened positive. Conclusion In conclusion, although the screening tests we adopted here were not sufficient to identify patients at high risk of aspiration pneumonia, perioperative interventions using a team approach might be effective in reducing the incidence of PP in elderly patients with gastric cancer. Author Affiliation: (1) 0000 0004 1774 9501, grid.415797.9, Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan (2) 0000 0001 1009 6411, grid.261445.0, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan (3) 0000 0004 1774 9501, grid.415797.9, Division of Dentistry and Oral Surgery, Shizuoka Cancer Center, Shizuoka, Japan (4) 0000 0004 1774 9501, grid.415797.9, Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan Article History: Registration Date: 03/06/2017 Received Date: 23/03/2017 Accepted Date: 02/06/2017 Online Date: 13/06/2017 Article note: Electronic supplementary material The online version of this article (doi:10.1007/s10120-017-0736-3) contains supplementary material, which is available to authorized users.
  • Identifier: ISSN: 1436-3291 ; E-ISSN: 1436-3305 ; DOI: 10.1007/s10120-017-0736-3

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