Severe pain from mucositis resulting from concomitant chemoradiotherapy (CCRT) is commonly treated with opioid analgesics. However, the period of use of opioid analgesics differs among individuals. We performed a retrospective cohort study of 46 patients who were treated with long-term opioid analgesics after CCRT for head and neck cancer. Among these patients, opioid analgesics were used for a median of 30 days. A comparative study was conducted between patients with long-term use of strong opioid analgesic drugs and those with short-term use. A significantly prolonged use of opioid analgesic agent was associated with cetuximab use (TPF vs. S-1 vs. Cmab, 35.0 vs. 44.1 vs. 180.7, p≤0.001). There were no psychiatric symptoms such as dependence and delirium. When patient background and chemotherapy selection are known, the possibility of severe oropharyngeal mucositis and the potential need for long-term opioid analgesics can be evaluated. Consideration of reduction or discontinuation according to pain after the end of treatment is important.

Purpose: Integrated care pathway (ICP) is structured multidisciplinary care plan that aim to improve the quality of care. ICP could be effective in providing quality End-of-Life (EOL) care in long-term care facilities (LTCFs). However, the outcomes and components of ICP for EOL care in LTCFs are not clear. Methods: We conducted a scoping review to identify the outcomes and components. We searched electronic databases (PubMed, CINAHL, Cochrane Library, PsycINFO, Ichushi) and conducted an additional hand search for relevant journal articles related to EOL care. We searched intervention and implementation studies for ICP in EOL care in LTCFs. Results: Thirteen papers met the inclusion criteria. We identified the following components of ICP: documents, education regarding EOL care and ICP, support by experts, and regular conferences among care providers. The effects of ICP were reported as reductions in transfers to hospitals and improvement in staff confidence regarding EOL care. Conclusion: With reference to the components of ICP identified in this study, ICP should be developed based on the characteristics of LTCFs, and the effects of intervention or implementation studies using a more robust design should be examined.

Objective: To explore the trajectories of hematologic data and palliative performance scale (PPS) scores among patients with terminal-stage cancer. Method: This was a retrospective observational study. We recruited all adult patients with solid cancer who received care from palliative care specialists and died in Komaki City Hospital between January and December 2016. Among these patients, we extracted hematologic data from the last 12 weeks and when 2 weeks passed since the last anti-cancer treatment, and PPS scores on the day of the hematologic tests. We calculated the means of weekly hematologic data and PPS scores, and explored their trajectories. Results: We recruited 204 patients (mean age, 70.9 years; women, 44.1%) and acquired 1157 hematological datasets. Albumin and C-reactive protein levels gradually decreased from 12 weeks and increased from 5 weeks, respectively, before death. White blood cell and lymphocyte counts respectively increased and decreased from 5 weeks. Creatinine and bilirubin levels rapidly increased from 3 weeks. Potassium levels increased from 1 week. PPS scores decreased from 4 weeks before death. Discussion: Deteriorations in nutrition or inflammatory status and white blood cell counts could antedate deterioration in PPS scores, and deterioration of visceral data and PPS scores could indicate prognosis on a weekly basis.

There were no reports about long survival predictors in palliative care settings. We divided categories into more than 31 days of hospitalization (short period hospitalization) and more than 61 days of hospitalization) (long hospitalization) and analyzed prognostic factors in multivariate methods. We measured the association between the long hospitalization and short period hospitalization groups with regard to terminal symptoms (cancer pain, delirium, nausea and vomiting, fatigue, and dyspnea) and treatment (hydration, continuous sedation, and opioids). In the more than 31 days of hospitalization group, sex (Odds Ratio 0.502), consciousness (Odds Ratio 0.258), and calcium levels (Odds Ratio 0.559) were statistically significant. In the more than 61 days of hospitalization group, the serum CRP level (Odds Ratio 0.254) was statistically significant and serum calcium level (Odds Ratio 0.376) exhibited a trend. The prevalence of fatigue and amount of hydration were significantly low in the more than 31 days of hospitalization group. There were no differences in terminal symptoms and treatment in the more than 61 days of hospitalization group.

Purpose: This study aimed to clarify the factors contributing to nurses’ attitudes toward terminal care in palliative care units (PCUs). Methods: We conducted a cross-sectional study of nurses in PCUs across Japan using an anonymous self-administered questionnaire, which was mailed to 103 ward managers and 1,671 nurses in PCUs to collect data about nurses’ sociodemographic characteristics. Their attitudes towards terminal care were assessed using the Frommelt Attitudes Toward Care of the Dying Scale Form B (Japanese version). Multiple regression analyses were used to identify the factors associated with attitudes towards terminal care. Results: After excluding missing data, valid responses were obtained from 93 ward managers and 1,112 nurses (response rates of 90.3% and 66.5%, respectively). Based on multivariate analyses, the subdivisions of “positivity of nurses’ attitudes toward terminal care” and “high recognition of the patient- and family-centered care” were associated with working in PCUs voluntarily (β=0.159, β=0.131, p<0.01). The former subdivision was associated with ten personal factors, including “experience as a nurse in a PCU” (β=0.125, p<0.01), “having a certification of End-of-Life Nursing Education Consortium Japan version Core Curriculum” (β=0.065, p<0.05). The latter subdivision was associated with four factors enhancing the PCU environment including “support for creative activities of patients and their families” (β=0.114, p<0.01). Conclusion: This study has suggested that gaining the experience at PCUs with multidisciplinary members on a basic palliative care education, a supportive specialized palliative nursing education, and expanding care system in PCUs are important for the positivity of nurses’ attitudes toward terminal care.

The purpose of this study was to clarify feasibility of a booklet for families of children dying with incurable cancer. Of 267 pediatric oncology specialists, 76 (28%) participated in this cross-sectional survey. Ninety-three percent of participants answered that they were “likely to use” the booklet, and 86% percent answered that they believed the booklet was “helpful” for families. Some participants described various advantages of its use as follows: “able to communicate something that is difficult to put into words,” “easy to understand for families,” “families can read whenever they choose to,” and “able to grasp the direction of dying.” In contrast, other participants described points of attention of use as follows: “optimal timing to bring out,” “acceptance of families,” “direction as interdisciplinary team,” “confidential relationship between families and interdisciplinary team,” “disinclination among health care providers,” and “information volume of the booklet.” Thus, our results validated feasibility of the booklet. In conclusion, pediatric oncology specialists should provide their support of utilizing the booklet for families and assessing each family condition and advantage/attention of using the booklet.

Objectives: We developed the multimodal program Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC program). The aim of our study is to show algorithm of the home-based resistance training prescription and its compliance. Methods: We recruited 30 patients aged≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three educational sessions were planned in 8-week study period. Our resistance training consists of 3 or 5 of following 5 exercises components: (1) sit-to-stand, (2) calf raise, (3) knee extension, (4) knee raise, (5) side leg raise. Physiotherapist chose optimal prescription according to the modified Borg-scale. We assessed patient compliance, and safety. Results: Median proportion of days in which patients performed full or modified exercise program was 91%. Adverse events possibly related to the NEXTAC program were observed in 5 patients and included muscle pain (grade 1 in 2 patients), arthralgia (grade 1 in one patient), dyspnea on exertion (grade 1 in one patient), and plantar aponeurositis (grade 1 in one patient). Patient physical function and physical activity were maintained during the study period. Conclusion: Our resistance training showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. Although this study was not designed to show the efficacy of the resistance training, our data indicate a potential protective effect on physical function and physical activity.

Since a skin infiltration of breast cancer may increase hemorrhage and malodorous exudates, it significantly reduces the quality of life. Local treatment is usually performed with zinc oxide starch, Mohs paste or its alternatives. However, the Mohs paste causes pain due to necrobiosis of normal tissues, while the topical therapy with zinc oxide starch ineffectively suppresses hemostasis and odor. We hereby report a case of an 86-year old woman with skin infiltration by breast cancer. The patient’s symptoms including bleeding, infection signs, odor, exudates, necrotic tissue objectively improved with Shiunko ointment, Zinc oxide starch, and Metronidazole (MNZ) combination therapy. The gauze was exchanged once a day and this treatment was simple and easy. The combination therapy with Shiunko ointment, Zinc oxide starch, and MNZ may become an effective new regimen for bleeding and odor from skin involvement in breast cancer.

Purpose: To review the current state and discuss future direction of research related to advance care planning (ACP) in Japan. Methods: We have conducted literature search in the Ichushi, CINAHL, and Medline database between January 2011 and November 2017 using Advance Care Planning (ACP) as a keyword. Extracted research articles were further selected using the definition of ACP by Sudore et al., and reviewed using integrative review approach. Results: Majority of selected 39 articles was descriptive studies exploring general knowledge and interests about ACP and end-of-life decision making. Although the number of studies examining prevalence or strategies to implement ACP gradually increased in later years during the search period, detail information about the definition of ACP and strategies were lacking and generalizability of the studies were limited. Conclusion: ACP research in Japan is in the burgeoning phase. Clear definition of ACP in Japanese context that will guide the research and robust and scalable research examining strategies to implement ACP is urgently needed.