Palliative care is sometimes difficult for medical staff to say to patients with cancer and their families. The late of using the term “palliative care” decrease the opportunity to know about palliative care for the patients and their families. The primary aims of this study were to reveal physicians’ and nurses’ usage of the term “palliative care”, time to use the term for the first time, and a synonym. We conducted a questionnaire survey to 387 physicians and 518 floor nurses at Hiroshima University Hospital in February, 2010. We analyzed the results of physicians and nurses separately. Two hundred and seventy-two physicians (response rate 70.3%) and 284 nurses (54.8%) answered the questionnaire. Many physicians (77.2%) and the majority of nurses (56.0%) explain with the term “palliative care”. the majority of physicians use the term when cancer cause any symptoms and at early stage. Some nurses (31.4%) couldn’t use the term “palliative care” before physicians explained the term. Nurses having longer experience tend to use the term regardless of physicians’ use. Many physicians use the term “palliative care” at early stage of cancer. Many nurses also use the term at early stage of cancer, but some nurses couldn’t use before physicians’ use.

Objective: This study aimed to reveal the relationship between the terminal care attitudes, personal attributes, and views on life and death of care workers in nursing and group homes. Method: An anonymous self-administered questionnaire survey was mailed to 772 staff members at nursing and group homes. We used the Frommelt Attitudes Toward Care of the Dying Scale Form B (Japanese version) and the Death Attitude Inventory, which is a scale of views on life and death, to form the questionnaire. Results: After excluding missing data, 338 staff responses were analyzed (valid response rate: 43.8%). The total terminal care attitude scores were significantly higher among managers compared to other staff members (β=0.182, p=0.001), and among those having provided end-of-life cared to 10 or more people (β=0.155, p=0.003). Additionally, the total terminal care attitude scores were significantly higher among those with lower scores in the “death avoidance” subscale (β=−0.183, p=0.001) and higher scores in the “afterlife beliefs” subscale (β=0.168, p=0.001) of the Death Attitude Inventory. Conclusion: Terminal care attitudes were influenced by job position, the number of persons provided with end-of-life care to, and views on life and death. We need to investigate factors that affect terminal care attitudes to ensure provision of high quality care in nursing homes.

Objective: To develop and to examine the feasibility of the Japanese version Bereavement Risk Assessment Tool (BRAT-J). Methods: Pilot survey was performed at three palliative care units and one home care clinic. Medical staff performed an assessment by using the Japanese version of BRAT (BRAT-J) to examine bereavement risk among families of cancer patients. Results: 25 individuals who had a cancer patient in their family participated in this survey. Of those 25 participants, 7 (28%) were classified as minimal risk, 8 (32%) were low risk, 9 (36%) were moderate risk and 1 (4 %) was high risk. Chi-square was used to test the association between risk level and each items of BRAT. Two items of BRAT, ‘heightened emotional states (anger, guilt, anxiety) as typical response to stressors’ and ‘lack of social support/social isolation (perceived or real)’ were significantly associated with the family member’s risk level. Conclusion: This was a pilot survey to examine the feasibility of BRAT-J in practice. Further qualitative investigation needs to be conducted to determine the appropriate support required for each risk level among the bereaved individuals.

Background and purpose: Terminal stage cancer patients often demand psychological care to retain quality of her/his life. The purpose of the present study is to report palliative interventions by a clinical psychologist for a patient with terminal stage breast cancer and coexisting long-term depression. Case report: The patient was a female of 49-years-old that had a history of an operation for right breast cancer and thereafter developed brain and left femoral metastases. The patient showed symptoms of anxiety neurosis due to depression and deteriorated activities of daily living after orthopedic operation for left femoral pathologic fracture. To palliate these symptoms, a clinical psychologist, a member of palliative care team made interventions alone and with members of treatment team and/or her family. The interventions were made through interviews of 30-minutes, twice a week, a total of 30 times for 6 months. Discussion: The psychologist recognized not only patient’s anxiety for cancer progression but also negative thinking mainly due to depression in the one-to-one interviews. The recommendation of the psychologist to be positive thinking and behavior could reduce the psychological symptoms. The psychologist organized conferences of a variety of medical staff and transferred information about patient’s psychological aspects, which facilitated effective communication between the patient and medical staff. Patient’s family attended the interviews with the patient to realize psychological problem and the attendance made them possible to collaborate on the palliative care. Conclusion: A clinical psychologist intervention was effective in reducing patient’s deteriorated psychological symptoms and enhancing QOL.

Objective: We describe a case of lung cancer complicated with esophageal achalasia (EA), which was successfully treated with endoscopic pneumatic dilation (EPD). Case: A 66-year-old woman was admitted to our hospital because of frequent episodes of emesis and dysphagia after receiving an escalating dose of sustained release oxycodone (SRO) for cancer-related multifactorial back pain. She had been diagnosed with EA and treated with EPD at the age of 50. Her symptoms were refractory to the conventional anti-emetic agents such as prochlorperazine and metoclopramide. Computed tomography imaging showed marked dilatation of the esophagus with food residue. We diagnosed EA based on the presence of rosette-like esophageal folds on endoscopy and narrowing of the esophagogastric junction on esophagography, and subsequently performed EPD, which alleviated the symptoms. Discussion: The effects of opioids on esophageal motility have not been elucidated thus far. Recent studies using high-resolution manometry reported that long-term use of opioids was associated with esophageal dysmotility similar to that observed in EA. Although we have no evidence to directly demonstrate the causal relationship between the use of SRO and anti-emetic agents and EA, we speculate that our patient’s symptoms might be associated not only with SRO-related emesis during the gradual worsening of EA, but also partly with the SRO-induced esophageal dysmotility and the constrictive effect of dopamine D₂ receptor antagonists on the lower esophageal sphincter. Care must be taken to avoid drug-induced esophageal motor dysfunction, which might lead to deteriorate EA.

Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.

More patients are now surviving cancer thanks to early diagnosis and improved treatment. Chronic pain in cancer survivors is problematic and the risk of chronic therapy with opioids includes abuse or addiction. We describe a patient with lymphoma whose behavior became aberrant while under treatment with opioid analgesics to manage anxiety after a painful tumor disappeared. Using opioid analgesics to manage emotional distress rather than pure physical pain has been defined as chemical coping, which is considered as an early stage of abuse or addiction. Knowledge of opioid analgesics and aberrant drug-related behaviors is necessary to manage chronic pain in cancer survivors.

The DOLOPLUS-2 scale was developed by Bernard Wary in 1992, and is a behavioral pain assessment scale for elderly individuals with verbal communication disorders. The scale comprises 10 items divided into 3 sub-groups. Each item has four levels of pain intensity, with scores ranging from 0 to 3. A score of ≥5 (out of a maximum of 30) indicates the presence of pain. In 2007, our team translated this scale from French into Japanese, and the translated version was validated in 2012. In this manuscript, I discuss the introduction and use of this scale based on the results of our research.