Palliative medicine, synonymous with “palliative care”, is defined as an approach not for cancer, nor for terminal illness to improve quality of life and not to hasten the death. “Total pain” consisting of physical, psychological, social and spiritual aspects is the key concept of palliative medicine, and we have to understand these four aspects of pain influence one another. Palliative medicine begun with hospice care is now regarded as applicable early in the course of illness, and we can comprehend that hospice care has become one model of terminal palliative medicine. In our country, although a government policy has made palliative oncology popular, some issues still remain unsolved : palliative medicine from the moment of cancer diagnosis, its quality improvement and application to nononcologic illness.

Ten years have passed since the Basic Anticancer Law was enacted. The promotion of palliative medicine is the policy of our country, and pain relief is one of the important themes. I’m sure doctors specializing in psychosomatic medicine could be of some assistance to relieve cancer pain in various ways. In this paper, in addition to referring to general pain relief, I would like psychosomatic doctors to be aware of the fact that psychosomatic medicine is useful to treat cancer pain. I would be happy to be of any help to answering daily clinical questions.

Dyspnea is a subjective symptom and highly prevalent in cancer patients. It is important to identify the causes of dyspnea in assessing dyspnea. Subjective symptom scale (e. g. numerical rating scale) is useful to assess the severity of dyspnea. With regard to treatment, treatments for the cause of dyspnea (e. g. radiation therapy or chemotherapy for cancer) should be specified first. Symptomatic treatment includes oxygen therapy, pharmacological treatment, and the like. Morphine is the first-line drug for dyspnea in pharmacological treatment. Concerning diseases relating to dyspnea, I also mention about malignant pleural effusion and death rattle.

Cancer patients often suffer from gastrointestinal symptoms associated with progression of disease or treatment and those symptoms disturb treatment and the quality of life of patients. Common gastrointestinal symptoms related to cancer include nausea and vomiting, constipation, and ascites. In the management of those symptoms, clinicians need to have good knowledge on appropriate assessment of cause and pathology and care combining pharmacological and non-pharmacological approaches.

Home care medicine entails a lesser degree of medical treatment than can be provided in hospital settings. Despite this difference, many patients who receive such services find a high level of satisfaction in remaining at home at the end of their lives. Through examining such trends, I argue that a home setting works effectively in terms of enhancing the resilience of these patients. The key factor that determines the resilience is total life support for the patients and their families as carers. In this process, it is particularly important that the patients and their families are supported to make informed decisions over their choice of location for palliative care. In addition, cooperation between the hospital and clinic—including the ‘Hospital Triangle’ —is also important when it comes to responding to the patient’s wishes. I conclude that psychiatrists can play a significant role in home care medicine, as they can treat both the physical and mental conditions of patients.

Background : Music is often used in medical institutions for its effect in relaxation and stress relief. This study investigates the relationship among listeners’mental health status, personal situation, and background music (BGM) preference and explores effective BGM selection in a medical institution. Method : College students answered a questionnaire containing questions based on the Center for Epidemiologic Studies Depression (CES-D) Scale and questions on BGM preference (100 valid responses). Result : Respondents with stronger depressive tendency had lower preference for BGM (p<0.05). A preference for music box sounds, nature sounds, happy/joyful songs, and passionate/intense songs were dependent on the listener’s personal situation. Many preferred fast-paced music when needing energy, and many preferred slow-paced music when anxious or having trouble sleeping (p<0.0001). Conclusion : A relationship between listeners’mental health state and BGM preference was confirmed ; namely, BGM preference differed according to the listener’s mental health state and personal situation. Appropriate BGM tempo, type of sound, and musical motifs must be considered according to the hospital environment and patient’s individual situation.

Background : As of March 2014, three years after the Fukushima nuclear power plant disaster, 58,624 residents were relocated to other regions within the Fukushima prefecture, and 47,683 residents were relocated to other prefectures. Attenuation of human relationships due to the disruption of regional ties nurtured in the past heightens stress. This highlights the need to create a new community focused on establishing ties with neighbors. Among evacuees, providing support for elderly adults suffering from a decline in physical functioning and a deteriorating mental health is necessary. Objective : This study investigated the relationship between individual social capital and mental health in elderly adults, specifically focusing on the role of social capital in reconstruction after the earthquake. Methods : A self-report questionnaire was conducted at Waseda University and Shinsai Shien Network, Saitama. Evacuees from Fukushima prefecture (n=3,599) who lived in Saitama prefecture and Tokyo were asked to complete the Stress Response Scale-18 comprising questions related to social capital with cognitive and structural indicators. There were 772 replies (response rate=21.5%) and 229 respondents were analyzed. In addition, a multiple logistic regression analysis was performed to examine the relationship between social capital and mental health in elderly adults. Results : The group with low confidence in neighbors relative to the group with high confidence in neighbors had a 5.192 times higher chance of being in the high-stress group (95%CI=1.042-25.865). In addition, the group with lower confidence in acquiring their neighbors assistance if a disaster occurred again, had a 2.172 times higher chance of being in the high-stress group (95%CI=1.051-4.487). Furthermore, people who have never participated in regional activities (e.g., hobbies, sports, entertainment, etc.) had a 3.112 times higher chance of being high-stressed relative to the group who participated two or three times (95%CI=1.059-9.150). Finally, the group that never greeted neighbors had a 3.317 times higher chance of being high-stressed relative to the group that had five or more greeted neighbors (95%CI=1.177-9.346). Conclusion : Lower social-capital cognitive indicators such as “trusting one’s neighbors” and “helping one’s neighbors” were correlated with higher stress levels. Therefore, elderly adults can presumably maintain good mental health by developing a neighborhood relationship and building mutual trust. Furthermore, lower social-capital structural indicators such as “number of greeted neighbors” and “participation frequency in regional activities” were correlated with higher stress levels. It is important to encourage social participation of evacuees and provide them with support.