Study on the Relationship between Carnitine Metabolism and Cancer-Related Fatigue after Cisplatin Administration in Cancer Patients

Cancer-related fatigue (CRF) is defined as a “persistent, subjective sense of physical, emotional and/or cognitive tiredness, related to cancer or cancer treatment.” This symptom is experienced by many patients with advanced or terminal cancer, as well as by roughly 70% of cancer patients receiving anti-cancer drug therapy, and causes a great deal of pain to patients, significantly diminishing activity levels and quality of life.

Although the pathogenesis of CRF is not clear, anti-cancer drug therapy, radiation therapy, cancerous cachexia, pain, anemia, dehydration, mental fatigue, sleep disorders, nutritional disorders, and other factors are considered to be related. Recent studies have also reported the possibility that decreases in the mass and strength of skeletal muscles may also be related to CRF. On the other hand, carnitine is an amino acid with a molecular weight of 161, that can be ingested through the diet or biosynthesized in vivo, and it is known that about 98% of it is stored within skeletal muscle. The main function of carnitine is to transport long-chain fatty acids to the inner mitochondrial membrane, playing an important role in energy production (ATP).

However, decreased plasma carnitine levels have been reported in some cancer patients, including cancer patients who have developed cachexia; it is also known that urinary excretion of carnitine is increased through the administration of platinum-based anti-cancer drugs.

It has also been reported that administering carnitine to tumor-bearing animals restores food intake, suppresses weight loss and muscle mass loss, and restores activity, suggesting that carnitine has effects on fatigue and exhaustion.

Administration of carnitine is reportedly effective in treating fatigue in cancer patients with carnitine deficiency, though there are few actual case studies. Therefore, we have decided to measure blood serum carnitine levels (free carnitine, total carnitine, and acylcarnitine) and urinary excretions (0–24 hours) in cancer patients who were scheduled to receive cisplatin, and to investigate changes in fatigue using the FACIT-F scale (questionnaire).

Patients who agree to participate in this observational study are asked to fill out the FACIT-F questionnaire (before, and one week after, the administration of anti-cancer drugs), and to allow us to measure muscle mass (including measuring upper arm circumference using a tape measure) and carnitine levels (using some of the blood and urine samples collected for early detection of anti-cancer drug side effects).

Verification of the Usefulness of a Community Cooperation Clinical Pathway and Palliative Care Teams in Home Palliative Care

Objectives of this study:

１）To elucidate, through a questionnaire survey, the reasons why and how it is useful for patients to use a tool called the Community Cooperation Clinical Pathway in Home Palliative Care developed in the Takaoka medical region of Toyama Prefecture; and/or for patients to have a hospital’s palliative care team visit their homes together with visiting nurses, general practitioners, and other community health care providers (community palliative care team activities) (process research)

２）To elucidate to what extent these two activities affect the proportion of patients who transition from receiving palliative care and other nursing care at a hospital to receiving this care at home, using a statistical technique called multivariate analysis (outcome research and factor research)

Some (but not all) patients who cooperate with this study, and their families, may be asked to participate in questionnaires and interviews at a later date, regarding topics such as how they feel about receiving home palliative care.

These questionnaires and interviews are non-obligatory; patients and/or family members who do not wish to participate are free to decline, and will not be penalized in any way for doing so.