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.

Objectives: This study aimed to describe the experiences of bereaved family members of cancer patients in terms of regret in relation to ending terminal treatment for the patient. Methods: We conducted a semi-structured qualitative interview of 37 bereaved family members regarding their decision-making and their psychological adjustment from the time they made the decision to terminate treatment. Interviews were analyzed using qualitative content analysis. Results: Approximately 40% of bereaved family members reported that they had some regrets about their decision. Regret contents were classified into 8 categories and diversified from 4 categories at the time of decision-making to 7 categories after the death. The reasons for regret were classified into 43 categories. Common factors that minimized regret included situations at the time when they made the decision, such as patient- and family-specific factors and relationship with the medical staff. In comparison, the common reasons for regret centered on factors related to the approach for decision-making, such as the process, options, as well as psychological coping and relationships with medical staff. Conclusion: The results suggest that regret in the bereaved could be modified by understanding the relationship between regret characteristics and psychological coping.

Understanding the symptoms of the general population has an important role in assessing and improving the quality of palliative care systems. However, there are no reliable epidemiological data on the symptoms of the general population in Japan. The aim of this study was to survey the actual status of the symptoms experienced by the general population in Japan. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. The Memorial Symptom Assessment Scale (MSAS) was used to multi-dimensionally evaluate symptoms experienced within the past week, and the Short Form 8™ (SF-8™) was used to assess the health-related quality of life (QOL). A total of 978 (41.1%) self-completed questionnaires were analyzed. The prevalences, severity rates, and distress rates of 35 physical and psychological symptoms were analyzed according to sex and age group. In addition, the relation between symptom severity and the health-related QOL score was evaluated. From the perspectives of public health and administrative policy, the results of this survey will most likely provide important basic data, with the ultimate goal of establishing a palliative care system in Japan.

Objective: To clarify the care-related difficulties faced by nurses newly assigned to a palliative care ward, and develop future perspectives on education and support for such nurses. Methods: Semi-structured interviews were conducted with 4 nurses at 3 points: 1) immediately, 2) 10 months, and 3) 1 year and 6 months after their assignment to the palliative care ward. The obtained data were analyzed, adopting the content analysis method developed by K. Krippendorff. Results: The difficulties faced by the nurses at each point included: 1) [realizing their own insufficient understanding of palliative care and repeating trials and errors to appropriately manage each situation] and [considering methods to benefit the most from their knowledge related to general wards, while developing anxiety over differences between such wards and this one]; 2) [becoming aware of the significance of active listening to patients with a short life expectancy and realizing their limited skills for it] and [difficulties and dilemmas caused by conflicts related to care policies]; and 3) [difficulty in making judgment regarding care due to an insufficient confirmation of patients’ intentions] and [becoming aware of the importance of establishing favorable relationships with patients/families]. Conclusion: Education and support for nurses newly assigned to palliative care wards should be continuously provided on a step-by-step basis through approaches, such as improving their active listening skills in the early stages, confirming their knowledge of interpersonal support and bioethics, and providing opportunities for them to examine each case.

Background: Almost all patients experience cancer-related fatigue (CRF) in advanced stage of cancer but only a few coping methods are known to be effective. Objectives: We conducted a study to evaluate the usefulness of acupuncture for cancer-related fatigue in terminal stage patients. Methods: Total of 16 cancer patients either hospitalized in palliative care unit or received intervention from palliative care team in Chiba University Hospital between August 2010 and March 2012 were included in the study. Acupuncture treatment (touching needle therapy) consisting of 3 interventions in two weeks period was added to usual care. The primary outcome measure was Cancer Fatigue Scale (CFS) and secondary outcome measures were Numerical Rating Scale (NRS) of fatigue and pain, and salivary amylase levels. Results: Thirteen patients completed the acupuncture therapy. While CFS scores showed no significant change, fatigue NRS and salivary amylase levels showed significant decrease after the treatment. No adverse effect was reported in this study. Conclusion: Our study suggests the possibility of acupuncture therapy in relieving fatigue sensation in patients with advanced cancer.

Identifying barriers regarding cancer patients’ transfer to palliative care units (PCUs) should help improve their quality of life and enable them to choose where to recuperate. The present study sought to define these barriers using a self-completed questionnaire survey of medical social workers and nurses at the discharge support and coordination departments of 424 cancer care hospitals nationwide. By exploratory factor analysis, Identified barriers to PCUs transfer included 11 domains. Our study suggested that the barriers experienced by medical social workers and nurses at the discharge support and coordination departments regarding transfer to PCUs can be reduced by sufficient explanation by physicians to patients, timely PCUs referral with psychosocial consideration, improvement of collaborative system in between cancer care hospitals nationwide, general hospital, PCUs and home medical care, clarifying adequate structure to identify the patient who needs admission to PCUs.

The purpose of this study was twofold: first, we aimed to clarify the kinds of desires expressed by patients admitted to the palliative care unit (PCU). Second, we investigated the relationship between the patient’s mobility, which is the length of time the patient can move, sit, stand, or walk rather than lie flat in bed, and his/her Palliative Prognostic Index (PPI) score in order to predict how long patients could tolerate mobilization and at what point patients could begin practicing mobilization in a rehabilitation setting. The subjects of the study were 76 palliative care patients. Half expressed a desire to go for an outing or visit their home, of which 70% successfully achieved. To investigate mobility, we collected a total of 480 weeks’ worth of patient PPI scores and mobility and analyzed the correlation between them. The analysis showed a negative correlation coefficient of −0.62 between PPI score and patient mobility. In addition, when estimating the cutoff value for mobility using the Receiver Operating Characteristic (ROC) curve, we found that a patient with a PPI score of less than 3.5 could aim for over 60 minutes of mobilization, while a patient with a PPI score of less than 4.5 could aim for 30 minutes or more. Those with a PPI score 5.5 or less were still able to mobilize slightly, but when the score exceeded 6.0, patients experienced difficulty with mobility for even short periods of time.

Good Death Scale (GDS) is a provider assessment scale of quality of dying of terminally ill cancer patients, and its reliability and validity has been confirmed. The aim of this study is translating the GDS into Japanese (GDS-J) according to the standard methods of conducting linguistic validation. In the forward translation, there was a disagreement in the translation of “will” into Japanese translation of “will” of GDS question 3 “Has the patient arranged everything according to his/her own will?” We confirmed linguistic validity in the research team and eventually got approval from the original author in writing and decided on GDS-J. Using the GDS-J, a quality assessment scale for palliative care by provider, it will be possible to evaluate the quality of palliative care to be done by themselves and to be expected to be useful for providing higher-quality palliative care.

Although continuous deep sedation (CDS) is sometimes used for terminally ill cancer patients to alleviate intolerable symptoms, there are few studies that comprehensively investigated CDS in general ward, including the rate of discussions by multiple occupations. The aim of this study was to retrospectively investigate the present state of CDS for patients in the general ward who were referred to the palliative care team (PCT). A total of 938 terminal cancer patients who were consulted with PCT between August 2012 and October 2015 were enrolled. Of the 938 patients enrolled in the study, 246 patients died in the general ward before the end of November 2015. Of the 246 patients, 28 patients (11.4%) were treated with CDS to alleviate intolerable symptoms in the terminal period. The mean duration of CDS was 4.1±3.1 days. Lung cancer was the most common in primary disease. The primary reason for starting CDS was dyspnea. All CDS were performed with midazolam. The discussions on CDS by multiple occupations were performed in all cases. We conclude that on weekdays the PCT visited the patient every day and was able to sedate all cases with sedation discussion by multiple occupations.

Aims: This study aimed to compare the difference in successful insertion rates of peripherally inserted central venous catheters (PICCs) between the different insertion sites at the cubital fossa (basilic, medial cubital and cephalic vein) for terminally-ill cancer patients at the bedside. Methods: Data from eighty-eight terminally-ill cancer inpatients who underwent insertion of PICC from September 2011 to April 2014 were retrospectively analyzed. Successful PICC insertion was defined when the catheter tips were placed in the superior vena cava. Results: PICC insertion was successfully carried out in 72/88 patients (81.8%) in total; 43/50 patients (86.0%) via basilic vein, 23/31 patients (74.2%) via medial cubital vein, and 6/7 patients (85.7%) via cephalic vein. There was no significant statistical difference between the three different approaches in the success rate of PICC insertion (P=0.39). Conclusion: Our findings suggest that the cephalic vein serves as an alternative puncture site of PICC insertion at the cubital fossa for terminally-ill cancer patients under unavoidable clinical circumstances.

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.