Advance Care Planning is an important factor to determine the quality of life for patients with advanced cancer. The primary aim of this preliminary study is to explore the preference of patients with advanced cancer for Advance Care Planning. We conducted the semi−structured interviews with 10 palliative care patients. A total of 9 patients of them stated that Advance Care Planning is valuable, but 1 patient evaluated it as not valuable. Participants had diverse views regarding the appropriate timing of Advance Care Planning (i.e., during anticancer treatment, at the recurrence, hospitalization, when the physician decided to need). The majority of participants preferred their primarily responsible physician to initiate the discussion. Participants had various opinions about a role of family members and a necessity of written documentation. The findings of this study suggested that physicians should confirm the patient’s intention about Advance Care Planning, judge the appropriate timing of discussion, and ask who should be present during the discussion. Larger study is needed.

View full abstract

Objective: The aim of this study was to investigate the palliative care for cancer patients provided by a long-term care unit. Methods: We retrospectively investigated the medical records of 194 patients who hospitalized in our long-term care unit between April 2010 and December 2014. The patients shared with a group of two, narcotic drugs non-use period (previous group; until March 2012) and narcotics use period (later group; in April 2012 or later), and it was compared with a background, hospitalization period, result on discharge, narcotic drug administration, symptom relief. And it was surveyed hospitalization dynamics of our palliative care unit for comparison. Result: Cancer patients were 16 (22%) in previous group of 74 patients and were 79 (66%) in later group of 120. The proportion of cancer patients in later group increased to three times (p<0.001). In later group, the average hospital stay was shortened to half (144 days, p<0.01) and the mortality discharge rates increased (78%, p<0.05). Narcotic drugs were administered to more than half (57%) of cancer patients in later group, and pain relief was significantly better. In the period of later group, number of hospitalized patients in palliative care unit was also increased. Conclusion: It was suggested that the long-term unit can perform palliative care for cancer patients in cooperation with the palliative care unit.

View full abstract

It was previously reported the safety and efficacy of oral tapentadol ER switched from other opioids for 8 weeks in subjects with moderate to severe cancer pain, who received opioid analgesics prior to study participation. All treatment emergent adverse events were evaluated in previous safety analysis. In this report, the incidence and timing of opioid specific adverse events related to tapentadol administration were analyzed and compared with those of morphine SR as a reference. Fifty subjects each was randomized to the tapentadol ER group and the morphine SR group. The incidences of major adverse events that are considered related to treatment in the tapentadol ER group and the morphine SR group were nausea (8.0%, 14.0%), vomiting (2.0%, 24.0%), constipation (8.0%, 20.0%), and somnolence (8.0%, 18.0%), the incidences of these events were lower in the tapentadol ER group. These results suggest that tapentadol ER is a orally opioid which has well safety profiles, and is a new option of cancer pain therapy.

View full abstract

Continuous subcutaneous injections of medication are effective in controlling symptoms of the terminal stage of cancer. Chlorpromazine and levomepromazine occasionally cause skin irritation. We examined all patients who underwent continuous subcutaneous administration of psychotropic drugs (chlorpromazine, levomepromazine, midazolam) at the palliative care unit of our hospital from April 2010 to March 2013, the frequency of adverse skin reactions of Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade 3 or above. Of the 603 hospitalized patients, 389 (64.5%) underwent continuous subcutaneous administration of one of the three drugs. The frequency of grade 3 or above (ulceration or necrosis) adverse skin reactions was 4 out of 345 chlorpromazine cases (1.2%; 95% CI: 0.0-2.3%), 2 out of 90 levomepromazine cases (2.2%; 95% CI: −0.8-5.2%), and 0 out of 210 midazolam cases (0.0%; 95% CI: 0.0-0.0%). The frequency of serious adverse skin reactions caused by continuous subcutaneous administration of psychotropic drugs was low, suggesting that this treatment is relatively safe for the skin.

View full abstract

End-of-life discussion with patients with advanced cancer is one of the important factors to determine the patient quality of life and their families' grief. The primary aim of this study is to collect Japanese medical oncologists' views toward end-of-life discussion. A context analysis of free comments of the questionnaire survey was conducted. Questionnaires were mailed to 864 medical oncologists, and 490 responses were obtained. A content analysis identified 420 free comments. As barriers of end-of-life discussion for oncologists, three types of barriers were emerged: 1) issues relating to patient and family (e.g., [individuality of the patient and family], [difficulty of acceptance of illness progression]), 2) issues relating to medical professionals (e.g., [a lack of psychological support], [difference in beliefs about end-of-life discussion among medical professionals]), and 3) health care systems (e.g., [a lack of time and human resources], [a lack of education and research]). The findings of this study may be useful to improve mutual understanding of oncologists and palliative care physicians when performing the end-of-life discussion in collaboration.

View full abstract

Objective: To examine the clinical significance of an opioid, tapentadol, for cancer pain relief including its analgesic effects and indications based on our clinical experience. Methods: We retrospectively studied 31 patients receiving tapentadol in our hospital. Results: In 19 successfully treated patients, the numerical rating scale (NRS) scores showed a significant decrease in pain, and the doses at the start and completion of administration were 73.7±25.6 mg (morphine equivalent dose: 30 mg or less) and 125±49.3 mg, respectively. Six successfully treated patients showed improvement of gastrointestinal symptoms. The results of the comparison between successfully and unsuccessfully treated patients suggested titration to be difficult in patients with mixture of somatic pain and neuropathic pain. Conclusion: Based on our clinical experience, we consider tapentadol to be easy to use during the introductory period after treatment with non-opioids or low-dose opioids.

View full abstract

Objective: To determine nurses’ and care workers’ role in caring for the dying on wards for recuperation under health insurance. Methods: The analysis was performed using semi-structured interviews involving 9 nurses and care workers working on wards for recuperation under health insurance and having experience of caring for dying patients. Results: As for nurses’ roles in caring for dying patients, 6 categories were extracted, including ‘support patients’ families to have a feeling that they were fully involved in the process of dying’. As for care workers’ roles in caring for dying patients, 5 categories were extracted, including ‘support nurse through the care worker activities’. Conclusion: In order to provide quality care for the dying, it is important to put the following points into practice: providing feedback and seculity on effects of daily life support, the provision of opportunities to enhance the independence of the care worker.

View full abstract

Introduction: SEIQoL-DW is a method of measuring the subjective QOL of each patient by focusing on five areas considered important by the patient in a semi-structured counseling session. The objective of this study was to longitudinally evaluate the shift in areas considered important by advanced-cancer patients along with the shift in the subjective QOL. Methods: Patients who underwent SEIQoL-DW at the time of palliative care visit (first session) and after palliative care hospitalization (second session) within 1 year, in addition to also meeting the inclusion criteria such as a pain level of STAS 1 or lower, were included as the study subjects. Results: A total of 5 cases (mean age of 67.6 years among 1 male case and 4 female cases) were included. The P.S. was 1 for all cases at the first session, among which 3 cases were undergoing chemotherapy. At the second session, the P.S. was 3 or 4 for all cases. The mean time between the two sessions was 164 days. In all cases, 3 or more of the 5 important areas changed at the time of the second session. The SEIQoL-index, which is a comprehensive subjective QOL, improved in 3 cases but decreased in the other 2 cases. Conclusion: The areas considered important by terminal phase patients widely change. The shift in subjective QOL of each patient does not necessarily correspond to the decrease in the P.S. level.

View full abstract

Introduction: Among various predicting tools of survival developed for terminally ill cancer patients, Palliative Prognostic Score (PaP) is used very frequently. The target diseases of PaP are solid malignancies other than renal cancer; thus hematological malignancies are not included in them. Objective: To demonstrate that it is appropriate and useful to apply PaP to patients with terminally ill hematological malignancies. Methods: We used PaP to predict the survival of 18 patients with terminally ill hematological malignancies hospitalized in our hospice ward and compared the prediction accuracy with that of the previous studies. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 21-day survival probability were 91.7%, 83.3%, 91.7%, 83.3%, and 88.9%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 30-day survival probability were 72.7%, 85.7%, 88.9%, 66.7%, and 77.8%, respectively. Conclusion: Our results suggest that it may be possible to apply PaP to patients with terminally ill hematological malignancies.

View full abstract

Long-term care facilities have important roles providing end-of-life-care in Japan. The purpose of this literature review was to examine the current research trend regarding quality evaluation and improvement for end-of-life-care in Japanese long-term care facilities. From a search of key medical databases, potential articles regarding end of life at long-term care facilities were retrieved. We classified retrieved 23 literatures into four research types; four intervention studies, three surveys for development educational / quality improvement tool, thirteen cross-sectional surveys, three qualitative studies. Despite the current increment of the literatures, intervention studies were a few. Related factors of the death in the facilities included administrators’ policy regarding end of life care, and collaboration with the medical institutions, and clear family decision making regarding end of life care. Some research indicated that staffs in long-term care facilities felt difficulty in collaborating with medical institutions, conducting interdisciplinary work, and confirming residents’ intention regarding end-of-life. The results indicate that conducting quality intervention study, supporting administrators of long-term care facilities, promoting residents and family decision making and education for the staffs in long-term care facilities might be effective to improve quality of end-of-life care in long-term care facilities.

View full abstract

Introduction: Paroxysmal atrial fibrillation (Paf) occurred in an inpatient who has been prescribed methadone for cancer pain in our palliative care unit, but oral administration of aprindine (antiarrhythmic agent) succeeded in defibrillation and methadone administration could be continued. Case: A 75-year-old man had developed multiple bone metastases after resection of thyroid cancer. Due to refractory cancer pain, switching from oxycodone to methadone was performed. Pain relief was achieved with methadone 40 mg/day and without QT interval prolongation. After methadone administration about 9 months, there suddenly became loss of appetite in the morning of one day. ECG examination revealed Paf onset. Aprindine 20 mg was orally administered for the purpose of defibrillation. After about 2 hours sinus rhythm was gained and later without recurrence. Conclusion: This case was considered to have the coincidental complication of paroxysmal atrial fibrillation in the course of methadone administration. If administration of antiarrhythmic agents is performed in a patient whom has been prescribed methadone, it is feared to lead to result in QT interval prolongation due to drug interactions. It is important to carefully select an agent that rarely leads to QT prolongation.

View full abstract

Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.

View full abstract

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patients and required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

View full abstract