With the goal of improving delirium in cancer patients, quetiapine suppositories were formulated in-hospital and their usefulness was investigated. A retrospective survey of medical records was conducted in 108 patients in whom quetiapine suppositories were used, out of 644 patients admitted to a palliative care ward between April 2011 and October 2014. Patient background information, circumstances of administration, degree of improvement in delirium (evaluation of degree of improvement in hyperactive delirium determined using the Agitation Distress Scale [ADS]), and side effects were investigated. In the overall group, including the quetiapine suppository group and the quetiapine suppository combined with another drug group, a significant decrease in ADS value was confirmed after administration of the suppository (p<0.0001), suggesting that this treatment contributed to improvement in delirium. The side effects were similar to those caused by the oral administration of quetiapine, and issues due to the formulation as a suppository were not observed. In conclusion, it was determined that quetiapine suppositories can be used simply and safely, and it is thought that quetiapine suppositories are useful for delirium in cancer patients.
Objectives: This study examined symptom assessments and non-pharmacological interventions to relieve symptoms among heart failure patients, and factors related to nurses’ attitudes towards terminal care. Method: A cross-sectional study was conducted with 180 nurses using a questionnaire. Results: Symptom assessments were conducted about 80% of the times for all 14 symptoms of congestive heart failure. Non-pharmacological interventions, such as adjustment in daily life, consideration of positioning and movement in daily life, and environment adjustment, were frequently conducted. Nurses who attended palliative care seminars indicated more positive attitudes toward terminal care including a positive attitude toward caring for dying persons. Low points in difficulties with terminal care reflected nurses’ knowledge and skills related to high points in positive attitudes toward caring for dying persons. Conclusion: These results suggest that educational programs are required for nurses providing palliative care for patients with heart failure to enhance nurses’ attitudes towards terminal care and to promote palliative care practice.
The aim of this study was to understand the use of complementary and alternative medicine (CAM) in cancer patients in Japan. This study was part of the Japan Hospice and Palliative care Evaluation 2016 (J-HOPE2016) Study. A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who died at palliative care units. Data suggest that 54% of cancer patients use CAM. In comparison with a previous study in 2005 in Japan, categories of CAM vary widely; CAM previously included supplements mostly, but now exercise and mind and body therapy are also used. Most cancer patients use CAM without any harmful influence on their household economy and cancer treatment; however, in some patients, CAM incurs a large expense and a delay in starting cancer treatment. Therefore, it is important for medical staff and patients to have an opportunity to discuss CAM use. Multiple logistic regression analysis shows that CAM use is significantly associated with younger patients and highly educated families; moreover, there is a possibility that family members who use CAM have a high level of psychological distress. We must pay attention to the physical and the psychological aspects of cancer patients who use CAM and their families. Further studies are needed to investigate the use of each category of CAM, and to understand patients who use CAM and who die at home or in hospitals other than palliative care units.
Objective: The aim of this study was to investigate the healthcare workers’ awareness and support regarding the sexuality of cancer patients, their families. Methods: A self-reported questionnaire survey was conducted on the healthcare workers in Shikoku Cancer Center on May 2014. Results: Four hundred and fifty-seven (84.9%) workers responded to the questionnaire. It was 29.8% who have communicated about sexual issues with patients and their families, 67.0% acknowledged the necessity of supporting them. In the group which had experience in communicating about sexual issues and participating in study meetings of sexuality, there were more healthcare workers who acknowledged the necessity of support significantly (aware group). In the aware group, the reasons why they hesitated and felt difficulty in communicating about sexual issues were that they had no chances to communicate with patients about sexual issues (93.5%), they didn’t know whether the patients needed intervention of healthcare workers (89.2%), they felt lack of their knowledge of support regarding sexuality (89.2%), and they felt lack of their skill of support regarding sexuality (88.9%). In the aware group, in order to get knowledge and information about sexuality, books and brochures which could be introduced to the patients and their families (96.4%) were considered to be most wanted. Conclusion: We have to make an effort so that all healthcare workers recognize the importance of the necessity of communicating about sexual issues with the patients, their families and their partners.
Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.
Backgrounds: Salivary dysphagia due to digestive tract obstruction from pharyngeal and cervical esophageal cancer is a major cause of drooling, and the retention of saliva in the mouth is annoying to patients. Case report: An 87-year-old woman with recurrent hypopharyngeal cancer after radiation therapy complained that she could not sleep at night because of continuous sputa accumulation, and that she had to repeatedly eliminate saliva throughout day. Intravenous betamethasone at dose of 8 mg per day provided symptom relief the day after its administration. Her score on the Support Team Assessment Schedule, Japanese version (STAS-J) for salivary dysphagia decreased from 4 before treatment to 1 within two days after the initial administration. The dose was decreased to 2 mg per day six days after the start of administration, but the symptom relief continued. No symptom recurrence was seen for the two months that steroids were administered. Discussion: Our STAS-J finding indicates that the anti-inflammatory effect of betamethasone produces a rapid response that is maintained for months in cases of stenosis due to malignancy. Conclusions: Treatment with high dose steroid has the possibility of the relief of suffering caused by difficulty swallowing saliva.
Objective: To determine the factors influencing the necessity of holding death conferences. Methods: Data of 416 cancer patients who died in the palliative care unit of the National Cancer Center Hospital East between August 2013 and February 2015 were reviewed. Patients’ medical charts and data sheets of conferences held after their deaths were analyzed. Results: A total of 25.7% of participants saw the necessity of holding death conferences. Multiple logistical regression analyses revealed four independent factors that influenced the holding of death conferences: age <50 years; length of stay in the palliative care unit ≥20 days; epidural analgesia; aphonia; and abdominal distention. Conclusion: These factors might explain nurses’ difficulty in providing end-of-life care for cancer patients.