A survey of practice in management of malignancy-related ascites in Japan

Abstract

Although ascites is a distressing complication observed commonly in the course of advanced cancer, there is no effective treatment established for malignancy-related ascites. We conducted a nationwide survey of cancer physicians in Japan who treat malignancy-related ascites in order to determine what kind of therapeutic approach is thought to be significant and what kind of diuretic prescriptions are thought to be standard for malignancy-related ascites. From 2017 to 2018, we sent a one-page memo to oncologists in Japan asking them to participate in a questionnaire-style survey that they could complete online. The significance of each of the nine representative interventions was measured on a 5-stage Likert scale. At the same time, participants were asked about what type and dosage of diuretics they thought to be standard as a treatment for malignancy-related ascites. Ultimately, 187 oncologists responded to our invitation. The interventions that were particularly significant were reducing hydration volume, paracentesis, and symptom management with analgesics. The respondents indicated that the importance of diuretics was significantly lower than that of these three interventions. Furthermore, 86.2% of the respondents in Japan regarded the use of loop diuretics ± aldosterone antagonists as the standard of diuretic therapy for malignancy-related ascites, and the most common regimen was 20 mg of oral furosemide ± 25 mg of spironolactone daily at the start, and 30–40 mg ± 50 mg daily at the time of initial escalation. Although our study revealed that the attitude of oncologists in Japan toward therapeutic options for malignancy-related ascites was nearly consistent with that of previous reports from other countries, it was newly found that they seemed to commonly be concerned with preventing overhydration of terminally ill cancer patients and that analgesics were also thought to be a significant form of intervention.

Ascites Is a Poor Prognostic Factor in Advanced Pancreatic Adenocarcinoma and May Be Undertreated: A Prospective Cohort Study

“…In this group, diuretics have been observed to be inconsistently used at proper doses despite reports of clinical efficacy and being a first-line treatment consideration ( 16 , 18 ). To the best of our knowledge, there are no clinical studies of diuretics in pancreatic cancer–associated ascites, and practicing oncologists rely on empirical therapy or guidelines for ascites due to cirrhosis ( 6 , 16 , 19 ).…”

Malignancy-related ascites in palliative care units: prognostic factor analysis

“…Patients with terminal cancer also benefit from reducing overtreatment and undertreatment. Common palliative treatments for MA in Japan have reduced hydration, paracentesis and the use of analgesics, although there is no established evidence for these 7. Paracentesis can be too invasive for frail patients in palliative care units (PCUs) (ie, inpatient hospices) due to adverse events such as hypotension, renal damage, visceral injury and infection 8.…”

“…Common palliative treatments for MA in Japan have reduced hydration, paracentesis and the use of analgesics, although there is no established evidence for these. 7 Paracentesis can be too invasive for frail patients in palliative care units (PCUs) (ie, inpatient hospices) due to adverse events such as hypotension, renal damage, visceral injury and infection. 8 The implantation of a peritoneal catheter is considered for patients requiring repeated paracentesis.…”