This study aimed to clarify cancer survivors’ experiences of changes in employment and the factors affecting their experience, quality of life (QOL) and mental health. We collected data from cancer survivors under 60 years of age (91 men, 269 women) through an Internet survey in December 2012. The results showed that in men, 22% experienced reduced working hours and 11% quit their jobs and in women, 8% experienced reduced working hours and 21% quit their jobs. These differences between males and females were statistically significant (P=0.000, P=0.031). The factors affecting changes in employment in men were being unmarried (P=0.002), a Performance Status (PS) score of more than 1 (P=0.008), and receiving pain treatment (P=0.039). In women, the relevant factors were a PS score of more than 1 (P=0.001) and time since being diagnosed with cancer (P=0.049). Physical and social quality of life were significantly lower in men who had experienced changes in employment, and all aspects of QOL were significantly lower in women who had experienced changes in employment. As for mental health, men and women who experienced changes in employment had significantly lower rates of depression and anxiety than those who experienced no changes. Furthermore, men who experienced changes in employment were significantly more likely to have psychological distress (P=0.027). We concluded that the experiences of changes in employment differed between male and female cancer survivors. Further investigations focusing on employment are therefore considered necessary for all cancer survivors.

Purpose: Through a survey of medical and nursing-care staff in long-term care units, we investigated the benefits and problems of the palliative care provided by long-term care units. Methods: Self-reported anonymous questionnaires were administered to staff who engaged in long-term care units. Questions included: awareness of the WHO definition on palliative care, the necessity and feasibility of palliative care in long-term care units, and the importance and the problems of practicing care, etc. on a Numerical Rating Scale (0: not agree-10: agree). Results: We got 541 responses from 30 facilities (387 medical staffs and 154 staffs from other occupations). The percentages of “I know the WHO definition” were 56% in medical staffs and 45% in staffs from other occupations. The mean scores related to cancer palliative care were 8.5±2.1 for the necessity and 6.8±2.5 for the feasibility. The mean scores related to non-cancer palliative care were 8.4±2.0 for the necessity and 7.0±2.2 for the feasibility. Highly-rated scores were important for pain relief and family care, shortage of staff and/or leaders of palliative care. Conclusions: Although the necessity of palliative care provided by long-term care units was highly needed, staff recognition of the feasibility was relatively low. The importance of palliative care was acknowledged, while a number of surrounding problems or difficulty were revealed.

Our aim of this study was to explore regional differences in the quality of end-of-life care, and complicated grief and depression among bereaved family members. This study was a secondary analysis of combined data from two previous nationwide bereaved family surveys. We used following data for analysis; demographic characteristics, scales to evaluate the quality of perceived care (Care Evaluation Scales: CES), patient’s achievement of a good death (Good Death Inventory: GDI), bereaved family member’s grief (Brief Grief Questionnaire: BGQ), and depression (Patient Health Questionnaire: PHQ-9). We compared the total score adjusted with demographic characteristics of each scale by region (reference=Kanto region). The Kyusyu-Okinawa region was significantly higher compared to the Kanto region for CES, and GDI (both p<0.05). The Chubu region, the Kinki region, the Chugoku region and Kyusyu-Okinawa region were significantly lower compared to the Kanto region for BGQ (all p<.005). Significant difference in region was not observed for PHQ-9 after adjustment. Despite the significant difference observed among regions, that effect size was small. The present study reports that there were few regional differences in the quality of perceived palliative care.

Objectives: This study aimed to clarify the presence and evaluation of eight types of support by medical staff for family members that aid the verbal communication of feelings to patients (i.e., verbal communication support for family members) in palliative care units. Further, the relationship between the presence of “verbal communication support for family members” and the variables of a “good relationship between patient and family,” and “overall care satisfaction” was assessed. Methods: A questionnaire was administered to 968 bereaved family members of patients who died in 103 palliative care units in Japan. Results: A total of 536 responses were analyzed. Although the proportion of the families who received support differed depending on the content, the evaluation of the support received by the families was positive overall. Multiple regression analysis showed a significant positive association (p<0.05) for all eight types of support and those family members who reported a good relationship between patient and family. The results also showed a significant positive association (p<0.05) between four support types (concrete proposal of families’ verbalization to the patients, telling to the patients the feelings that families want to convey, ensuring that the patients can hear, and words to families that imply the patient’s feelings toward his/her family) and overall care satisfaction. Conclusion: Identifying methods to improve medical staff’s “verbal communication support for families” in daily care may ultimately strengthen the relationship between patients and their families as well as lead to their increased satisfaction with care.

The aims of this study are 1. to evaluate the usability of workshop to introduce and manage distress screening effectively and efficiently and to use it for cancer patients and their family and 2. to consider the appropriate subject of workshop. All of the participants answered the questionnaire on the site (n=51). Their knowledge about screening practice, various screening tools and how to use screening tools and data from screening tool were significantly improved after the workshop. The workshop was highly regarded by participants. Thirty-eight of fifty-one patients responded to web questionnaire three months later (Response rate: 75%). More than thirty percent of participants put into practice what they learned in the workshop. The workshop decreased factors to interfere screening practice three months later. Knowledge about how to use screening tools was negatively correlated to number of cancer patients at hospital where participants worked and number of their hospital beds. And factor to interfere screening practice was negatively correlated to how long participants were involved in palliative care team. This study indicated the usability of workshop to spread screening triage program regarding cancer patients’ distress. The workshop may be appropriate for medical staffs who have relatively much experience of palliative care team and who have difficulty in screening practice at designated cancer hospitals where number of cancer patients is relatively large.

Purpose: To clarify the differences in the interpretation between the medical staffs and the patients / their families (hereinafter called “patients-families”) when the wording like “a yearly, monthly or weekly basis” and “the words suggesting seasons” are used on the medical sites. Method: The questionnaires were provided to both the medical staffs and the patients-families. Results: Regarding “a yearly basis”, 100% of the medical staffs use as “less than five years” and 67.1% of the patients-families interpret the same. Regarding “a monthly basis”, 100% of the medical staffs use as “less than six months” and 68.3% of the patients-families interpret the same. Regarding “a weekly basis”, 100% of the medical staffs use it as “less than eight weeks”, whereas it is 77.2% of the patients-families that interpret so. Approximately 20% of the patients-families have no ideas about the wording like “a yearly, monthly and weekly basis”. When the medical staffs mention “the cherry blossom season”, 71.4% of them are trying to indicate “the late March” or “the early April”, on the other hand, it is 58.9% of the patients-families that understand so. Regarding the expressions like “the season when the leaves turn red”, “the time when it gets warmer” or “the time when it gets colder”, there is not definite mutual understanding between the medical staffs and the patients-families. Conclusion: This awareness survey shows there is a case that the medical staffs and the patients-families may differ in the interpretation of words commonly used on medical sites.

Purpose: The aim of this study was to extract factors for home-visiting nurses to determine family caregivers who need support after bereavement. Methods: A questionnaire was constructed and administered to 105 family caregivers of terminally ill patients. Using the survey responses, factors were extracted that would allow home-visiting nurses to judge the necessity of bereavement support before and after the deaths of the patients. Of the 105 family caregivers, 30 consented to participate in the survey. Researchers interviewed the 30 family caregivers using the Center for Epidemiologic Studies Depression Scale and the SF-8^TM health survey to assess the health-related quality of life. The obtained data were analyzed using the mathematical quantification theory class II. Results: The extracted factors included: the existence of a disease under medical treatment, the existence of dissatisfaction with medical services, the existence of the economic burden of a disease, a married couple consisting of persons aged over 75 years, family members living in the home who tended to leave care to the primary caregiver, no reliable family members or relatives outside the home, and a tendency to refrain from requesting others’ help (the discrimination hit ratio was 76.7%, the correlation ratio was 0.42, and P=0.001). The criterion-related validity of judgments by home-visiting nurses was verified. Conclusion: These seven factors were revealed as important for determining family caregivers who need support after bereavement.

Objectives: To explore background factors contributing to learning needs among physicians in palliative care specialty training. Methods: We conducted a questionnaire survey of physicians in specialty training in palliative care who were within 15 years after medical school graduation. The unmet learning needs (referred to as “needs”) were evaluated on a 5-point scale. Factor analysis was performed to identify underlying subscales of needs. Univariate analysis was performed using an average score of each subscale as a dependent variable and background factors as independent variables. Results: Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. Factor analysis identified six subscales of the unmet learning needs: research, time, specialist, network, quality, and comprehensiveness. Background factors with significant between-group differences with the effect size of 0.4 or more included: 1) not working at a certified training facility, 2) not working or training at a big hospital, and 3) the number of palliative care physicians being 2 or less in the facility. Conclusion: Improvement of the training system is urgently needed for young physicians who are working at small or non-certified facilities for specialty training, or who have few palliative care colleagues.

Dexamethasone (DEX) is used to palliate symptoms of malignant bowel obstruction (MBO). The aim of this study was to investigate the extent of oral intake in MBO patients treated with DEX. We conducted a retrospective chart review of all patients (N=262) admitted to our palliative care unit and treated with DEX for MBO (N=10) from October 2016 to September 2017. The diagnostic criteria for MBO were clinical signs of MBO (medical history, body findings, and image findings), obstruction distal to the Treitz ligament, and the presence of incurable primary intra-abdominal or extra-abdominal cancer with peritoneal involvement. An increase in oral intake was observed in 6 patients over an average of 3.8 days. The initial dose of DEX was 8 mg/day in all patients. The results suggest that DEX might improve oral intake in patients with MBO.

Objective: Our aim is to investigate the status of palliative care in long-term care units in the hospitals established without any palliative care unit, and to explore challenges to facilitate the palliative care in the setting. Methods: Self-administered anonymous questionnaires were sent to the administrators of 211 institutions for long-term care in Tokyo, asking their status of management and usage of medical narcotics, the presence/absence of any doctor or nurse who has expertise in palliative care, the system and protocol for acceptance of cancer patients into their setting, their view about palliative care for non-cancer patients, and the difficulties encountered in palliative care at long-term care units. Results: Fifty five institutions responded. Although 89.1% of them have been accepting cancer patients and are qualified to use medical narcotics, doctors who have expertise in palliative care are present only in 32.7% of the institutions. More than 70% of them place importance on and have been practicing palliative care for non-cancer patients. The difficulties in expert knowledge/skills, narcotic administration, and pain palliation were significantly more frequent in the institutions staffed by no doctors having expertise in palliative care. Conclusion: Many long-term care institutions have been practicing palliative care for cancer/non-cancer patients, but they are encountering several difficulties. It is suggested that the presence of doctors having expertise in palliative care would decrease such difficulties.

The standard route of administration of opioids is oral, although the route of administration of opioids changes to subcutaneous in cases such as dysphagia, nausea and vomiting. We report a rare complication of abdominal cellulitis following opioid subcutaneous administration. The patient was a 44-year-old man, was diagnosed with gastric cancer. Oxycodone was continuously injected subcutaneously to relieve pain, and the patient continued to receive chemotherapy. However, abdominal cellulitis developed at the site of subcutaneous injection. Continuous subcutaneous injection was halted, and an antibiotic drug was administered for 1 week; as a result, the cellulitis resolved. Afterward, the patient was able to continue receiving chemotherapy. It is necessary to pay attention to the puncture site and signs of infection when administering opioids subcutaneously, such as continuous subcutaneous injections of oxycodone.

We report on the case of a 68-year-old male patient with repeating attacks of syncope caused by the growth of parapharyngeal space lymph node metastases from oropharyngeal cancer. He received chemotherapy after a tumor resection. After that, he received radiation therapy for metastases to cervical lymph node and cervical spine. Because he was not able to consume a meal, he was hospitalized but started repeating syncope attacks with severe headaches. According to the CT images, it was suspected that this syndrome was caused by parapharyngeal space lymph node metastases, and radiation therapy was provided. After the therapy, the attacks of syncope disappeared and didn’t reappear for three months before the death. We recommend that the examination for head and neck malignancy should be done when repeating syncope attack occurs, and radiation therapy can be the choice for the symptom relief in such cases.