Japan’s population of the elderly aged over 65 years has reached a record high. As a result, the number of patients with oral cancer is increasing yearly.
Elderly patients are characterized by decreased physical and cognitive functions, the presence of comorbidities, reduced life functions, economic problems, and changes in social and family relationships. However, these vary greatly from person to person, and making judgments based on chronological age alone is difficult. Treatment of elderly patients with cancer should be conducted by understanding these characteristics. However, there are no appropriate guidelines that provide indicative criteria for treatment and prognosis, and the treatment has been conducted based on empirical rules in clinical practice. Therefore, the Japanese Society of Oral Oncology has established a committee to create clinical practice guidelines for the elderly with oral cancer; guidelines for medical staff, patients, their families, and government officials are now being prepared and will be published soon.

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Oral cancer patients require various types of management in the terminal stage, including oral intake restriction due to locoregional lesions, airway management due to neck lesions, and exposure of wounds due to tumor progression. The aim of this study was to evaluate the current state and environment of end-of-life care for terminally ill oral cancer patients by conducting a survey. We retrospectively surveyed terminal oral cancer patients who had visited the Oral Cancer Center, Tokyo Dental College over the past 12 years. During the observed period, 133 patients advanced to the terminal stage, with the primary lesion located in the mandibular gingival area in 51.9％ of cases, and locoregional recurrence being the cause of death in 35.3％ of cases. A total of 69.4％ of patients were able to receive care at their preferred location. Our hospital provided end-of-life care for many patients who required respiratory management.
To create a desired end-of-life care environment for the patient and family, it is recommended to modify airway management and nutritional management. We work together with various professions to facilitate shared decision-making and improve the quality of life for patients and their families, ensuring that they can have a satisfactory end of life in a suitable location. The Ministry of Health, Labour, and Welfare advocates advanced care planning （ACP） to comprehend and share patients’ values and life goals, potentially enhancing the quality of life for many oral cancer patients at the end of their lives.

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