Purpose: There are many cancer patients who hope to be able to walk to the toilet for as long as they can before death. However, there are no reports of investigation of the ability of advanced cancer patients to go to the toilet, and how the symptoms affect this ability at the end of life in these patients. Methods: We retrospectively investigated the ability of advanced cancer patients to walk to the toilet during their final month of life in our palliative care unit. Data of a total of 154 patients who had died of cancer between January 2010 and December 2011 （median age 75.0±11.6 years） were analyzed in the study. In addition, we compared the frequencies of the symptoms （pain, shortness of breath, drowsiness, delirium, opiate use, oxygen use） between the walking group and the non-walking group. Results: Of the 154 patients, 79 （51.3%） were able to walk to the toilet in the month before their death, 54 （35.1%） in the two weeks before their death, and 33 （21.4%） in the final week before their death. The walking group showed more shortness of breath as compared to the non-walking group. The non-walking group showed more delirium and drowsiness. Conclusion: This study showed that the ADL are relatively preserved in terminal cancer patients. There is the possibility of providing support to their physical ability by rehabilitation. The consciousness level and shortness of breath should take into consideration to provide rehabilitation.

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To monitor the quality of life （QOL）of cancer patients through the Patient Behavior Survey, a large population-based survey, we developed a short QOL and quality of care （QOC）questionnaire. In order to help evaluate QOL in cancer patients, we also conducted a web–based survey designed to evaluate the content validity and interpretability of the questionnaire. In total, 630 cancer patients completed the survey. For each item, the result that more than 90% responses determined the item was of importance indicated that the item was important for living with cancer. Regarding items related to QOC, satisfaction with care, we consolidated responses; for example, the answer of “neutral” could also be interpreted as “almost satisfied” and patients who answered “other” may also mean that the item does not apply to them. We found that this questionnaire accurately evaluated the QOL of cancer patients and the responses were interpretable and presentable.

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The aim of this study was to clarify diet and meal preparation for terminal cancer patients followed at home. A cross-sectional survey was administered to bereaved caregivers of 200 cancer patients who received home care from five palliative care clinics in Kobe in 2014. The response rate was 66% and the average age of the caregivers was 62 years. Overall, 57% of caregivers reported distress regarding diet and meal preparation for patients. The independent determinants of distress were: the experience of coaching from medical staff （P=0.012）; how to help patients with eating; difficulties in cooking and meal preparation （P=0.001）; and helping with eating for anorexic patients （P=0.004）. Due to the paucity of the evidence about diet and meal preparation for cancer patients, caregivers may not be receiving sufficient specific and practical dietary instruction from medical staff.

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Background: Methadone can only be administered orally in Japan. However, it is unclear how to treat pain when patients become unable to take methadone orally because of the progression of the disease. Aims: To assess retrospectively end-of-life pain control management after patients become unable to take methadone orally. Methods: Twenty-eight patients with cancer pain undergoing treatment with oral methadone died at a palliative care unit between April 2013 and September 2014. All patients died of cancer and were unable to swallow before death. We assessed pain control approaches after the patients became unable to take methadone orally. Results: Twenty-one patients survived 1 day or longer after becoming unable to swallow. Methadone was switched to another opioid because of pain. Of these 21 patients, 10 patients survived for 1 week or longer after being switched to another opioid. At this point, methadone would be mostly eliminated from the blood circulation. Among these 10 patients, seven patients were treated with subcutaneous morphine, and three patients were excluded because their pain could not be evaluated. The conversion ratio from final oral methadone dosage to oral morphine equivalent dose of opioids used on the seventh day was 6.1. Conclusion: Even when patients become unable to ingest methadone, switching to other opioids may not always be necessary because of the long half-life of methadone when pain is absent at the end of life. If necessary, pain could be managed by switching to other opioids with a conversion ratio of 6.1.

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Objective: To develop and confirm the validity of a Biological Prognostic Score using only blood test results for prediction of prognosis in patients with advanced cancer. Methods: We conducted parametric survival time analysis using blood test results, age, sex, and primary diagnosis as independent variables, and event of death as a dependent variable, among patients in a palliative care unit (a development cohort). We then developed the Biological Prognostic Score (BPS). Thereafter, we confirmed the accuracy of the BPS and the Palliative Prognostic Index (PPI) prospectively among patients, who withdrew or withheld further curative or life-prolonging therapies, in other facilities (a validation cohort). Results: We developed the BPS, which consists of cholinesterase, blood urea nitrogen, and total iron-binding capacity, from 122 patients in a development cohort. We then examined 195 patients in a validation cohort and found that the area under the receiver operating characteristic curve for 1-9 week survival prediction was BPS=0.76-0.86 and PPI=0.69-0.73. Discussion: Our results suggest that the BPS was valid. It will be necessary to perform further examinations in multiple facilities and to explore more generalized parameters that could replace total iron-binding capacity in our BPS.

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This study sought to determine whether the Japanese version of the Liverpool Care Pathway （LCP-J） could improve nurses’ practice in dying-phase and difficulties with palliative care in a general ward. Between July 2014 and June 2015, LCP-J intervention and educational program for nurse were introduced in a general ward. The primary aims of this study were to clarify the changes in self-reported practice and difficulties of nurse before and after the interventions. Self-reported practice and difficulties were measured using Palliative Care Self-Reported Practice Scale （PCPS） and Palliative Care Difficulty Scale （PCDS）, respectively. The secondary aim was to clarify the defference in treatment, care and examination within last 48 hours between LCP-J patients and non-LCP-J patients. We obtained 21 responses in pre-intervention and 22 responses in post-intervention surveys from eligible nurses. Significant improvements were noted on domain of dying-phase care in PCPS and domain of alleviation of symptom in PCDS （3.00±1.16 versus 3.52±0.61 [p=0.042], 3.56±0.78 versus 3.10±0.63 [p=0.015], respectively）. LCP-J was used for 9 dying cancer patients （40%）, and no significant difference in treatment and examination within last 48 hours between LCP-J patients and non-LCP-J patients. LCP-J in general ward may improve nurses’ practice in dying-phase and difficulties with alleviation of symptom. In addition, considering the burden of LCP-J, to develop a useful checklist and educational interventions for dying patients is promising.

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Introduction: We report a case of intractable nausea due to zoledronic acid-refractory hypercalcemia for which the nausea was alleviated with denosumab, thereby improving quality of life. Case: A 54-year-old woman presented with metastatic renal pelvis cancer. Elevation of serum calcium level and nausea were noted. After multiple antiemetics were administered with no appreciable symptomatic improvement, treatment with zoledronic acid resulted in a decrease in the calcium level and an improvement of nausea from Japanese version Support Team Assessment Schedule （STAS-J） 3 to 1. After the third dose of zoledronic acid, the corrected calcium level was 11.8 mg/dl, indicating refractory. Because no improvement in nausea was noted, treatment with denosumab was initiated. After the treatment, the calcium level decreased to 9.4 mg/dl, and nausea improved from STAS-J 4 to 0. The patient could spend good time with her family, albeit for a short time, and no progression of the symptoms or adverse events due to denosumab occurred until her death. Discussion: Denosumab appears to be useful for improvement of intractable nausea in zoledronic acid-refractory hypercalcemia.

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Introduction: Double dose of Goreisan was effective in a case of blepharophimosis due to facial edema caused by malignancy-related superior vena cava syndrome. Case: A 60-year old male patient diagnosed with squamous cell carcinoma of the tongue underwent brachytherapy, surgery, and several types of chemotherapy before cervical lymph node metastases developed. Cyberknife therapy was performed to reduce the volume of lymph node metastases, only to develop abscess and cause malignancy-related superior vena cava syndrome, leading to facial edema accompanied by blepharophimosis. Intravenous furosemide was not effective, so double dose of Goreisan, a traditional Chinese prescription was applied and the edema and blepharophimosis subsided immediately, thus enhanced the patient’s quality of life. Conclusion: Goreisan can be an effective option for cases of malignancy-related superior vena cava syndrome refractory to chemotherapy and/or radiotherapy.

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