The aim of this study was to clarify the prevalence and characteristics of breakthrough pain in cancer patients. We conducted a cross-sectional survey of consecutive patients older than 20 years of age admitted to a University Hospital with a cancer diagnosis Breakthrough pain was defined as meeting all of the following criteria： Pain 1）with background pain present most of the time, 2）which is well controlled, 3）with short-lived episodes of exacerbation. One hundred and sixty-nine patients were recruited and 118（69.8％）completed the survey. Of these 118 patients, 11％（95％CI：7–18％）had breakthrough pain. Breakthrough pain occurred in 23％（14–35％）of patients with cancer-related pain and 29％（17–45％）of patients with pain from the cancer itself. Patients reported episodes occurring up to three times a day,a time to peak intensity of within 5 minutes, and a duration of untreated episodes of up to 15 minutes are 54％（29–77％）, 54％（29–77％）, 54％（29–77％）, respectively.

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　Recently, the amount of oxycodone used for palliative care in the medical setting has markedly increased in Japan. As the beneficial effects and pharmacokinetic profile of oxycodone are dependent on patient characteristics such as gender and age, it is important to understand the relationships between adverse effects and patient characteristics when administering oxycodone therapy to patients suffering from cancer-related pain. Therefore, we used the Japanese Adverse Drug Event Report Database administered by the Pharmaceuticals and Medical Devices Agency, Japan, to analyze the frequencies of adverse events associated with oxycodone therapy. Furthermore, the statistical significance of the associations between adverse effects and background parameters, such as age and gender, was determined using Fisher’s exact test and odds ratio. As a result, it was found that delirium, nausea, and vomiting are the most common adverse events seen after oxycodone administration. These symptoms are also caused by morphine and fentanyl. Nausea and diarrhea in female and interstitial lung disease in male reported more frequently. On the other hand, somnolence and delirium in elderly patients reported more often than in young patients. These findings might be helpful for managing the adverse effects of pain therapy on an individual basis.

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The persistence of attitudes toward terminal patients acquired by nursing students from lectures and class-based practical exercises is unclear. The present study investigated whether attitudes persist following palliative care education. Sixty-four nursing students taking a course in palliative care participated in a questionnaire survey using the Frommelt Attitude Toward Care of Dying Scale, Form B, Japanese version before, immediately after, and three months after lectures. The responses of 46 students were analyzed. Attitudes were more positive after lectures. At three months after lectures, both “I. Positivity towards care of dying patients” and “II. Awareness of care focused on the patient and their family” had returned to baseline. Students in this analysis included some who had experienced a relative’s death or who had been present during their dying moments. Despite their experience, three months after lectures there was no different from the students without such experience. Some more approaches are needed to influence the maintenance of a positive attitude toward terminal care.

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Purpose：To explore a methodology for evaluating end-of-life （EOL） cancer care using diagnosis procedure combination （DPC） administrative data. Methods： We investigated care provided to inpatients whose deaths were attributed to cancer and occurred between August 2010 and December 2012. We measured the quality of palliative care by dividing the decedents into two groups： those who died in the palliative care unit （PCU） and those who died in the general wards（GW）. Results： A total of 311 inpatient deaths were identified as cancer deaths. Of these, 147 patients were included in the PCU group and 164 in the GW group. We calculated the DPC data as follows： the rates of chemotherapy administered within 30 days before death （PCU 0％, GW 27％） and within 14 days before death （PCU 0％, GW 10％）, admission to the intensive care unit （PCU 0％, GW 2％）, life-sustaining interventions （PCU 0％, GW 3％）, rehabilitation sessions （PCU 10％, GW 26％）, emergency admission （PCU 2％, GW 27％）, and antibiotics （PCU 32％, GW 28％）. In the PCU group, rates of chemotherapy and emergency admission were significantly lower（＜0.0001；＜0.0001, respectively）, and rehabilitation sessions were significantly higher （p＝0.0002） than in the GW group. Conclusion： EOL care in a university hospital can be easily investigated using DPC data. Some limitations are the single-site study design, the health insurance system, and secondary use of administrative data. However, this methodology may be adapted to investigate the entire Japanese claim database and to evaluate EOL cancer care.

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Purpose： The aim of this study was to create a list of psycho-social problems and solutions for patients with pancreatic cancer by applying the social problem-solving process. Methods： A semi-structured interview of approximately 1 hour was conducted on two occasions. The participants were 17 patients with pancreatic cancer. Results： Psycho-social problems were divided into two themes: “facing the future uncertainty” and “facing the effects of treatment received”. A list of problems and solutions was created for each problem theme. Realistic goals for “facing the future uncertainty” were ‘maintaining this living condition （n=7）’, ‘preparing for changes to the environment （n=5）’, ‘keeping a sense of control over my own life （n=5）’ and ‘dealing with anxiety （n=3）’. Realistic goals for “facing the effects of treatment received” were ‘restoring the self of pre-illness（n=2）’. Conclusion： For seemingly unsolvable problems, patients can formulate realistic goals that they want to have clarified, and then the problems can be recaptured as solvable problems.

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Purpose：Methadone is an opioid used in Japan for the treatment of cancer pain. A thorough consideration of complex pharmacokinetics with individual differences and of serious adverse effects is necessary before switching to methadone; therefore, methadone is not yet widely used. We examined the analgesic and adverse effects of methadone through clinical cases and considered the clinical significance of methadone as an opioid analgesic for the treatment of cancer pain. Methods：The clinical course of 44 patients with cancer pain who were switched to methadone from other opioids was analyzed. Results：Out of the 44 cases investigated, 37 cases （84.1％） were successful. In the successful cases, pain intensity before and after methadone administration was reduced from an average of 7.5 to 2.8, respectively, on the numerical rating scale. Strong drowsiness （six cases） and nausea （three cases） were observed as adverse effects. However, no serious effects, such as QT prolongation and respiratory depression, were recognized. Conclusion：For patients with refractory cancer pain who require a high opioid dose, methadone is considered to be one of the alternatives in pain therapeutics.

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Purpose: The aim of this study was to characterize the process of adaptation experienced by the spouses of allotransplanted male patients following discharge. Methods: We conducted semi-structured interviews with six spouses and questioned them about the difficulties experienced in daily life following the discharge of their husband, and their coping strategies. We descriptively analyzed the interview data using the modified grounded theory approach. Results: We extracted ‘habituation of combating communicable diseases' from “responsibility for making effort,” “management of everyday life, ”confidence derived from experience “ and “habituation in the family.” We also extracted ‘change in anxiety and concern' from “perception of differences in attitude in daily life between husband and wife,” “change in the sense of values,” “finding a point of compromise in each family,” “benefit from allotransplant,” and “persistent anxiety.” Conclusion: The females habituated themselves to combating communicable diseases by gaining self-efficacy so that they reconciled a new, fixed lifestyle with their husbands following allotransplantation. Although their anxiety and concerns changed over time, they had persistent anxiety about both their husbands' health, including the risk of relapse or graft-versus-host disease, and financial hardships.

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Objectives: Primary aim of this study was to clarify the experience and evaluation of families who about caring the body of the deceased patient by nurses at Japanese inpatient hospices and palliative care unit. Method: A mail survey was performed on 958 bereaved family members of 103 palliative care units. A total of 598 family members replied. This study was content analysis about free comments in the questionnaire. Result: A total of 301 comments from 162 questionnaires were identified as the subjects for content analysis. The family was experience satisfaction or dissatisfaction about the way caring the body of the deceased patient. The family felt hesitation and worries about caring the body of deceased patient. A content analysis revealed 3 underlying themes: the family evaluate as a good experience, the family evaluate as an unpleasant experience, the family evaluate as an experience of hesitation and worries. Conclusion: The family was satisfied about treating the patient in the same way before died, making patient face beautiful and calm, facilitates family’s preparation. When nurses recommend families to care the body of deceased patient, which become memorably experience, and they come to be get over sorrow after the bereavement. But they need to confirm the family’s preparation and choose what they can do.

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　The objective of our study was to examine delays between onset of symptoms and treatment for malignant spinal cord compression （MSCC） and to investigate outcomes of neurological function. We performed a retrospective study of clinical records for 25 patients who had been diagnosed with MSCC at a regional center hospital. Thirteen patients had a history of malignancy at the onset of MSCC and 12 patients had no history. For most patients, pain was the first symptom of MSCC. Pain preceded neurologic symptoms by approximately 2 months. The median delays from onset of symptoms of MSCC to treatment were 49 days for all patients, 79 days for those without a history of malignancy and 41.5 days for those with a history of malignancy. It took 39 days from onset to consultation at the hospital, 7 days from consultation to diagnosis and 11 days from diagnosis to treatment. Neurological status was not exacerbated in 8 of 9 patients who had no other neurologic dysfunction at the time of treatment, while only 4 of 10 patients who had deterioration of motor or sensory function at the time of treatment showed improvement in neurological status. In conclusion, there were many delays in all processes from onset to treatment for MSCC and these delays resulted in poor outcome of neurological function.

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Objectives：To clarify effectiveness of educational workshop in advance care planning (ACP) and clinical ethics based on education for implementing end-of-life discussion (E-FIELD) program. Methods：Pre-post questionnaire survey. We held workshop in ACP and clinical ethics based on E-FIELD program. We measured participant’s knowledge of ACP and difficulties of End-of-Life (EOL) discussion before and after the workshop. Results：In 37 participants, 34 participants finished the course. Improvement of knowledge of ACP and clinical ethics in post workshop survey was statistically significant (pre. 18.1 v.s. post 23.9, p<0.001, paired t test). In terms of difficulties of EOL discussion, 7 items in all 13 items questionnaire were improved significantly in post workshop survey (p<0.05, Wilcoxon rank sum test). Conclusion：Educational workshop in ACP and clinical ethics based on E-FIELD program may improve knowledge of ACP and reduce difficulties of EOL discussion.

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Introduction：Halo-vest is usually used temporary to immobilize the cervical spine after surgery or injury. We experienced a good pain relief by halo-vest attachment in one patient with metastatic tumors of cervical spine. Case：A 76-year-old male patient was diagnosed with cervical spine metastases during chemotherapy treatment for lymph node recurrence 7 years after the first surgery for his esophageal cancer. His neck and back pain did not improve even after pain management by analgesics and radiotherapy. He also experienced strong side effects due to opioid treatment. Eventually, he became immobile. Halo-vest was applied solely for the purpose of pain control. Since then, his pain diminished, opioid stopped and his gait recovered. After moving to a hospital close to his home, he was discharged from the hospital. He could stay at home without a severe complication and opioids for 2 months. Discussion：Fixation of the cervical spine with halo-vest might be a good procedure for pain relief in patients with cervical spine metastases. However, since it could also be a stressful treatment and might cause a severe complication, thorough discussion for the use of a halo-vest is mandatory with the patient, family, and orthopedists.

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Introduction: To our knowledge, there is only one report of lactic acidosis in a patient with prostate cancer and no such report in Japan. We describe a patient with terminal stage prostate cancer who showed marked elevation in lactate dehydrogenase (LDH) levels and lactic acidosis. Case Report: The patient was a 66-year-old man diagnosed with prostate cancer and bone and liver metastases. At the time of diagnosis, he was being treated with the best supportive care after chemotherapy and hormone therapy for prostate cancer. He was admitted to the hospital for nausea and loss of appetite. Laboratory tests showed elevated LDH levels (11,894 IU/L; LDH4, 23%; LDH5, 32%); pH, 7.402; pCO2, 13.2 mmHg; HCO3−, 8.0 mmol/L; and lactate level, 10.0 mmol/L. On the basis of the results, the patient was diagnosed with lactic acidosis. He showed tachypnea the day before his death. Conclusion: Elevation in LDH levels, and especially of LDH5, indicates acceleration of anaerobic glycolysis from tumor cells, leading to the accumulation of lactate. The patient’s tachypnea was possibly caused by lactic acidosis.

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Background: Although rectal tenesmus in patients with advanced cancer can have marked negative impact on quality of life, effective treatment has not yet been established. Case: A 71 -year-old man with an inoperable rectal cancer developed tenesmus 11 months after a colostomy. Tenesmus worsened over the following 3 months, and the patient suffered from involuntary straining every 5-15 minutes. After unsuccessful symptom control with radiotherapy to the primary lesion, we started oral amoxapine 25 mg that alleviated symptoms related to tenesmus. As the general condition deteriorated, however, oral intake became difficult. After the discontinuation of amoxapine, the tenesmus recurred even though intravenous administration of clomipramine was initiated. We started continuous infusion of intravenous lidocaine 200 mg/day which successfully relieved tenesmus. The dose of lidocaine was subsequently increased to 290 mg/day for worsening symptoms, which continued to control his distress caused by tenesmus until he died. Consideration/Conclusion: This is the first report that demonstrates the efficacy of oral amoxapine for rectal tenesmus with malignant tumor. After the discontinuation of amoxapine due to the inability of taking medications orally, symptoms remained under adequate control with infusional lidocaine until the patient died. Further studies are warranted to confirm our findings and to propose optimal use of medications in the management of rectal tenesmus.

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We report a case of Paclitaxel-induced peripheral neuropathy successfully treated with lafutidine and tocoferol nicotinate(TN). Case Report: A 72-year-old male patient with pulmonary adenocarcinoma of left upper lobe, and metastasis of the liver. He suffered from the feelings of pins and needles of the limbs after the paclitaxel treatment, and admitted to our hospital. There was almost no remarkable change in the feelings of pins and needles with TN at 300mg per day, however, after addition of lafutidine at 20mg per day, those symptoms improved markedly, and he came to be able to walk alone. Therefore we reduced the dose of TN, those symptoms got worse. We restored TN to 300mg per day again, then these symptoms got better and he came to walk alone out of doors again. Consideration: Administration of lafutidine with TN improved the paclitaxel-induced peripheral neuropathy. Since the speed of the regeneration of the peripheral neurons is slow and changing the dose of TN affected the symptoms immediately, we considered that the improvement of the feelings of pins and needles of the limbs is due to the synergistic effect of the increase of the microvascular bloodflow of TN and lafutidine, and the effect of desensitization through the capsaicin-sensitive afferent neurons, although the hypothesis needs further investigation.

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Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

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Introduction：Although psychosocial support for cancer patients, their family, and those who are bereaved is essential, it is still considered inadequate. Anyone can become a member of the “Gan Cafe” support group, such as those suffering from cancer, those who have survived cancer, family members of cancer patients and those who have lost people to cancer, can get psychosocial support and palliative care support from palliative care unit staff. Case：A 53-year-old male was diagnosed with lung cancer in 2001 and underwent surgery. In 2006 he underwent chemotherapy, as he suffered a relapse. In 2012, while undergoing treatment, he joined the “Gan Cafe” along with his family members. He was able to interact with other members of the group and with the staff of the palliative care unit as a cancer patient, while his wife and children could interact with them as cancer patients family members. Six months later, when being admitted to the palliative care unit, the patient and his family members felt secure as they had become well acquainted with the staff at the “Gan Cafe.” After he had passed away, the wife continued to participate in the “Gan Cafe” as a bereaved family member and the same staff provided her with grief support. Conclusion：Through participation in the “Gan Cafe”, the staff of the palliative care unit was able to provide continuous palliative care with a focus on psychosocial support from the pre-hospital stage to grief support after the patients passed away.

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Currently, world-wide practice palliative care from early stage is underway. However, the practice has a variety of issues. “Palliative oncologist”- both trained Oncology and palliative care- have been proposed. Kawasaki municipal Ida hospital, from oncology ward, palliative care, and home in one sector and offers by using this system training programs have been conducted. Fellows can experience the anticancer treatment and palliative care. It may be useful Palliative oncologist training in Japan, and training program at our hospital would be a model.

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