Centralization of cancer care increases survival but increases the travel burden (i.e., travel durations, distances, and expenditures) in visiting hospitals. This study investigated the travel burdens to access cancer care for children aged 18 years and younger in Japan. The study population comprised 10,709 patients diagnosed between 2016 and 2019 obtained from a national population-based cancer registry in Japan. Their residences were classified as urban or rural. We counted the number of patients treated at specialized hospitals and investigated the treatment centralization across diagnostic groups by Pareto plot. Travel burdens to access care were estimated using a route-planner web service and summarized using median values. A multivariable logistic model was performed to investigate factors associated with the events of car travel duration exceeding 1 h. Of the patients, 76.7% lived in urban areas, and 82.5% received treatment in designated hospitals for childhood cancer. The Pareto plot suggested that the top five hospitals treated 63.5% of patients with retinoblastoma. The estimated travel burdens for all patients were 0.62 h (0.57 h in urban areas and 1.00 h in rural areas), 16.9 km, and 0.0 dollars of toll charges. Regarding travel duration, 21.7% of patients had travel exceeding 1 h, and rural areas, retinoblastoma, malignant bone tumors, and childhood cancer-hub hospitals were associated with travel duration exceeding 1 h (adjusted odds ratios of 6.93, 3.59, 1.94, and 1.91, respectively). Most patients were treated in specialized hospitals and the treatments for specific diseases were centralized. However, most patients were estimated to travel less than 1 h, and the travel burden tended to increase for patients in rural areas, those with specific diseases, and those going to specialized hospitals. Cancer control measures in Japan have steadily improved centralized treatment while keeping the travel burden relatively manageable.

Background: Serum C-reactive protein (CRP) levels are correlated with patient outcomes in cancer. This study aimed to determine associations between the CRP level and the dietary intake, symptoms, and eating-related distress (ERD). Methods: We conducted a multicenter survey among advanced cancer patients. Information on patient characteristics was retrieved from the electronic medical records. Data on patient outcomes were obtained through the questionnaire. Patients were categorized into the low CRP group (<5 mg/dL) and the high CRP group (≥5 mg/dL). Comparisons were calculated using the Mann–Whitney U test or chi-squared test. To assess associations between CRP levels and ERD, multivariate logistic regression analysis was performed. Results: A total of 191 patients were enrolled and divided into the low CRP group (n = 117) and the high CRP group (n = 74). The high CRP group had a more reduced dietary intake (p = 0.002) and more severe appetite loss (p = 0.008). The total scores of the ERD questionnaire (both the long and short versions) were significantly higher in the high CRP group (p = 0.040 and 0.029). The high CRP group also had significantly higher risks for ERD, as assessed using the long and short versions of the questionnaire (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.10–4.11; OR 2.06, 95% CI 1.05–4.05). Conclusions: High CRP levels were significantly associated with reduced dietary intake, appetite loss, and ERD. A serum CRP value of 5 mg/dL may be a useful indicator for initiating cancer cachexia care.

Objectives: This multicentre, retrospective study aimed to evaluate differences in drug continuation rates and efficacy between first- and second-line use of biological DMARDs (bDMARDs) and Janus kinase inhibitors (JAKi) after failure of the initial therapy in real-world RA settings. Methods: Data from an observational multicentre registry of patients with RA in Japan were analysed, encompassing 5900 treatment courses (4046 bDMARD/JAKi-naïve cases and 1854 second-line cases). Gray’s tests were used to compare the cumulative incidence function (CIF) for drug discontinuation, considering discontinuation due to remission as a competing risk. Competing risk analysis using Fine–Gray model was conducted to analyse the hazard ratios after adjusting for potential confounders. Changes in the Clinical Disease Activity Index (ΔCDAI) and disease activity score (ΔDAS28-CRP) were assessed at each time point compared with baseline using a linear mixed model with covariate adjustments. Results: Among the TNF inhibitors, IL-6 inhibitors, Cytotoxic T-lymphocyte associated protein 4 (CTLA4) and JAKi, only JAKi showed no significant difference in CIF of first- and second-line treatments. Competing risk analysis showed that consistent with the CIF analysis, second-line treatment influenced the drug continuation rates for all drugs except for JAKi. In analysing CDAI and DAS28-CRP trends using a linear mixed model, JAKi demonstrated similar efficacy as first- and second-line therapy, unlike other drugs. Conclusions: JAKi maintained continuation rates and efficacy in second-line treatment compared with first-line treatment, which is potentially advantageous over bDMARDs for patients with RA who require a change in initial therapy.