Backgraund/Aim/Method: Hepatocellular carcinoma (HCC) is a serious life-threatening disease. When HCC is advanced, moderate to severe pain is frequently found due to bone metastasis, requiring the administration of opioids. However, HCC develops in cirrhotic liver in most cases those are decreased in drug metabolism. Careful monitoring is therefore required when opioids are administered to patients with cirrhosis or HCC because guidelines about the administration of opioids are not established in Japan. In this report, we retrospectively analyzed cases treated by opioids and discussed about problems in current opioid treatment for advanced HCC cases. Results: The median duration of opioid treatment is about two months, and seems to be prolonged in cases with treatment of HCC. Prophylaxes for hepatic encephalopathy were done in about 10% of cases, and hepatic encephalopathy was developed in about 40% of cases after opioid treatment. Conclusion: In administration of opioids for advanced HCC, we should consider the onset of hepatic encephalopathy and make an effort to prevent it.

View full abstract

Objective: The aim of this study is to explore the factors associated with the burden of home care for doctors. Methods: In July 2013 a survey was mailed to a cross-section of clinics and hospitals in Kobe City. Results: Questionnaires were sent to 1,589 clinics and hospitals and 899 (57%) responded. Of these, data from 807 respondents were available for analysis. The burden of home care was felt to be considerable for 30% and slight for 31% of respondents. Determinants associated with the burden of home care were; 80 years and older doctors (P=0.05), particular medical measures (P=0.036), building links with other medical facility or care staff (P=0.002), and ensuring the sufficient time and staff (P<0.001). Conclusion: The majority of doctors reported a burden associated with home care.

View full abstract

Purpose: This study was conducted to verify the reliability and validity of a scale evaluating the quality of communication and cooperation among medical, nursing, and welfare services in a region. Methods: To apply "a measure to quantify the quality of communication and cooperation among health care providers in a region" (Morita et al, 2013) developed for health care professionals engaged in the care of homebound patients to broader profession and disease categories, the measure was modified to newly establish the 26-item "measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region." In total, 362 health care professionals were enrolled in this study. Results: The internal consistency was excellent. Exploratory factor analyses identified the factor structure as being identical to that of the original scale. The total score had negative but significant correlations with subscales for difficulties in regional cooperation on the Palliative Care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, and the number of persons to whom the respondent could inquire about support. Conclusion: This scale may be useful for describing the extent of global communication and cooperation among medical, nursing, and welfare services in a region.

View full abstract

Objective: The objective of this research is to categorize longitudinally the effects of events prompting or hampering the continuation of home care of terminal cancer patients to the places of their deaths in order to identify patterns for such events. Methodology: Semi-structured interviews were held with 17 visiting nurses. Focusing on the two cases where the patient died at home and in the hospital, the reasons for requesting hospitalization and any change in the situation during home care, the response of the visiting nurse to the situation at that time and others were determined. Results: The patients who died at home were categorized into 1) the patient had wanted home care or death at home, 2) the patient experienced events that prompted and hampered the continuation of home care but continued home care until the end, and 3) the patient died at home owing to the earnest desire of the assistant caregiver. The patients who died in hospital were categorized into 1) the patient decided on hospitalization because the symptoms became severe, 2) the patient had wished for home care but faced multiple events that hampered the continuation of home care, and 3) the family of the patient had been less willing to provide care and hospitalized the patient due to according to the opinion of the doctor. Conclusion: By longitudinally categorizing the events that prompted or hampered the continuation of home care, this research may give useful suggestions for appropriate measures based on those patterns.

View full abstract

Purpose: We evaluated the significance of support for leaving the palliative care unit temporarily in end-stage terminally ill cancer patients. Methods: We retrospectively investigated the medical records of 27 terminally ill cancer patients who died within 15 days after leaving our palliative care unit temporarily, between January 2011 and December 2012, and distributed a questionnaire to their bereaved family. Results: The age of the patients ranged from 29 to 91 years. Ten patients left the unit without stay and 17 left overnight. The destination of 24 patients was their home, while three had other destinations. For 11 patients, the main purpose of leaving the unit was to finish business, and for 9, was to see their houses once again. After returning to the hospital, the comments of 15 patients were affirmative, and those of 6 were negative. Questionnaire responses were obtained from 18 persons. Families reported anxiety regarding and difficulty with adaptation to the sudden change when the patients left the unit, apparatus support, patient transfer, and patient care. Conclusions: It was useful for the terminally ill cancer patients and their families to receive support when leaving the palliative care unit temporarily. Strategies to cope with the sudden change at the time of leaving the unit could help families feel reassured and secure.

View full abstract

Objectives: The purpose of this qualitative study was to examine the experiences of cancer survivors who used a palliative day care salon on a university campus. Method: Semi-structured interviews were conducted with ten cancer survivors; thereafter, we performed content analysis. Results: Ten categories were identified. The following were identified as motives to participate in the activities of the salon: (1) need for spiritual support, (2) desire to discover the meaning of life. The following experiences were described regarding the salon: (3) a place to express emotions openly, (4) a place to engage in activities as one pleases, (5) a place to communicate with others and express one’s true feelings, (6) a place that instills vigor as a result of expert advice. The following changes were identified after participation: (7) adopting an appropriate lifestyle, (8) improvement in image during the recurrence of cancer and towards the end of one’s life, (9) better family and social relationships, (10) a broader range of activities and uplifted sense for playing their roles. Discussion: Cancer survivors require support. In the salon, they could openly express their true feelings about their experiences of cancer and readily accepted one another. Further, their perceptions and attitudes toward life were being transformed through an enhanced sense of self-awareness. This transformation was facilitated by free activities on the university campus, an assurance of physical and psychological safety, and an indication of an outlet for such transformation.

View full abstract

Introduction: Oxaliplatin is a platinum anticancer drug effective for colorectal cancer. However, it causes acute and cumulative peripheral neuropathy in more than half of colorectal cancer patients, enormously impacting their daily lives. While it is important to manage peripheral neuropathy, no management method has yet been established. Case Report: A woman in her 60s underwent SOX therapy for recurrent colorectal cancer and experienced the onset of peripheral neuropathy in early stage of treatment. She did not respond to continuous administration of pyridoxal phosphate hydrate and goshajinkigan. She was thus instructed at the pharmacy to apply ointment containing 1.35% l-menthol 3 times a day at a dose of approximately 0.5 to 1 g to the affected sites on both feet. The symptoms started to show alleviation from the first day of application. She continued applying the ointment for one month until the end of SOX therapy and had no recurrence of symptoms. Conclusion: It was suggested that the application of ointment containing 1.35% l-menthol was effective for ameliorating peripheral neuropathy.

View full abstract

Aim: Many methods aiming to achieve face-to-face, multi-discipline healthcare cooperation have been attempted in Japan in order to optimize the community care system. There are however, many obstacles to the commencement or successful coordination of meetings, seminars, and workshops for health care professionals, particularly longterm cooperation and financial constraints. We have developed methods to solve these problems. Methods: We invented a new method, called Care Café based on the philosophical and sociological ideals utilized by the World Café. Care Café is held on a regular basis to facilitate communication and cooperation between healthcare professionals with the aim of finding solutions to mutual problems. Results: Care Café has been held on a monthly basis in Asahikawa, where it started. There have been 9 Care Café events in Asahikawa so far, with the number of healthcare professionals in attendance totaling approximately 700. The concept of Care Café is earning greater recognition in Japan, and Care Café events have now been held in 16 different Japanese cities, for an aggregate total of 29 events nationwide. We have received Care Café reports from participating cities detailing successful multi-discipline healthcare cooperation in solving medical issues. Conclusions: Care Café started in Asahikawa. It has been spreading among healthcare professionals nationwide. We expect Care Café to establish and develop new face-toface, multi-discipline healthcare cooperation.

View full abstract