Objective: The present study was conducted to determine the level of awareness about the difference between short-acting opioid (SAO) and rapid-onset opioid (ROO) formulation. Methods: A questionnaire survey was conducted to evaluate levels of awareness regarding the definition of cancer breakthrough pain, how to use the ROO formulation, and the difference between SAO and ROO formulation among physicians, nurses, and pharmacists. The surveillance period is between December 1, 2017 and December 31, 2017. Results: We received responses from 35 physicians, 102 nurses, and 171 pharmacists. The awareness of the difference between SAO formulation and ROO formulation across all occupation groups was approximately 3.8 in 11 steps from 0 to 10. Regarding the appropriate use of the ROO formulation, there was a tendency for variation among respondents in awareness about items referring to “the starting dose” and “the starting dose does not depend on the daily dose of the opioid analgesic administered on time.” Conclusion: The results of the present study suggest that it is necessary for each healthcare professional to reconfirm their knowledge of ROO formulation in the future and ensure appropriate administration.

Objective: In Japan, consultations by self-help groups (SHGs) and peers play an important role in supporting cancer survivors. This study aimed to clarify motives of cancer survivors who established and have managed an SHG for over 10 years. Methods: (1) Study participants: We recruited participants from cancer patient associations and support center of cancer core hospitals all over Japan. Among 18 applicants, 12 applicants who had experience with establishing an SHG were chosen as subjects. (2) Study procedure: We conducted semi-structured interviews between December 2015 and August 2016 to ask about motives for establishment and intentions to continue. (3) Analysis: We analyzed the data both qualitatively and inductively with a focus on the significance of continuing the activity of SHG. Results: Reasons for long-term continuation of SHG were: ‘a mission as a long-term survivor/witness’, ‘firm belief in the importance of sharing an experience with a cancer’, ‘significance of participant’s increasing autonomy and involving repaying is becoming a life work’, ‘continuation of the connection with medical staff’, ‘features of consultations by professionals and those by peer supports’, ‘equal relationship with medical staff’, ‘continuation by developing successors’, and ‘suggestions for medical care’. Conclusion: The study showed that a sense of fulfilment, a mission as a lifework, fear of recurrence even after 10 years, and desire to connect with medical staff supported the activity of SHG. For future research it is necessary to accumulate data targeting a longer term survivor more widely.

The purpose of this research was to develop a reflection program to support the practice of end-of-life care for nurses and to examine its effectiveness and feasibility. We developed and examined the effectiveness of a facilitator-based reflection program (FRP) and card-based reflection program (CRP). Average scores for both the FRP and CRP were measured using a Knowledge, Attitude and Difficulty Scale for palliative care and Self-education Ability Scale implemented before, immediately after, and 3 months after the program. The changes in scores were compared. This research was conducted with approval from the ethics review committee. Nine people participated in the FRP, and 15 in the CRP. FRP significantly reduced difficulty concerning palliative care compared to CRP. FRP significantly increased knowledge compared to CRP. Similar results were obtained within the FRP group. Both FRP and CRP were considered highly feasible because the program evaluation was high. In the future, it is necessary to clarify the effect of the reflection program by reviewing the research design.

Purpose: The present study aimed to clarify the status of exercise and related factors among survivors of breast cancer. Methods: Questionnaires were distributed to survivors of breast cancer. The question items addressed the status of exercise participation, knowledge about the effects of exercise and need for support. Factors associated with exercise participation were analyzed using logistic regression analysis. Results: Among 293 valid responses (rate, 84.2%). Fifty-eight point four percent participated in exercise and 41.3% decreased exercise participation after being diagnosed with breast cancer. Furthermore, 91.9% needed support from health care providers regarding exercise. About 70% of respondents were aware that exercise improves sleep, but <50% knew that exercise ameliorates symptoms associated with breast cancer. Among seven factors, age, employment status and chemotherapy were associated with exercise status. Conclusion: Breast cancer survivors who are younger, employed and undergoing chemotherapy might not participate in exercise. The preventive effects of exercise on breast cancer and the importance of continuing daily exercise should be promoted. Health care providers should provide support for patients to participate in exercise considering the influence of treatment and physical capabilities.

Purpose: To clarify the relationship between cancer pain self-management and pain in outpatients with advanced cancer taking opioid analgesics. Methods: 56 patients were surveyed using a questionnaire, which included items on cancer pain self-management deductively extracted from previous studies and items from the Japanese version of the Brief Pain Inventory. Results: Among patients self-managing their cancer pain, scores for “facilitation of around-the-clock opioid analgesics compliance” were significantly lower than scores for “interference with life”. Scores for “enduring end-of-dose failure pain” were significantly higher than scores for “severe pain”, “average pain”, and “interference with life”. Scores for “use of rescue doses when pain occurs” were significantly higher than scores for “sleep”. Scores for “methods to relieve pain other than analgesics” were significantly higher than scores for “mood”. Conclusions: The present study suggested that pain relief should be based on the use of opioid analgesics, and indicated the importance in pain relief of pain treatment that ensures good sleep and support for achieving self-management including holistic care.

Introduction: The purpose of this study was to identify the current status, issues, and training needs of nurses in terms of the appearance care for patients who undergo cancer therapy. Methods: Self-administered anonymous surveys were mailed to a total of 2,025 nurses. Potential respondents included five nurses who work at various departments in all the 400 Designated Regional Cancer Centers and Hospitals in Japan, or who accessed the Appearance Care Research Network website voluntarily and registered for study participation. Survey items included demographics and the 94 items concerning appearance care for changes associated with cancer therapy. The data analysis included descriptive statistics and logistic regression analysis to identify correlates of the provision of appearance care. Textual responses were qualitatively and descriptively analyzed. Results: Seven hundred and twenty six (35.9%) usable responses were returned. The respondents had a mean age of 42.5 (a range of 24 through 62) years. As a result of the survey, 93 out of 94 care items were carried out by respondents. Correlates of healthcare professionals’ appearance care provision included “collecting information from various sources” and “having confidence in providing care.” Seventeen categories of issues related to appearance care were created, including various items such as “appearance care is not standardized, and recognition level is different between healthcare professionals.” Discussion: Based upon the identified issues and needs of this study, an effective training program will be developed for healthcare professionals who provide appearance care for patients undergoing cancer therapy.

To clarify nursing practices in pain management of community-dwelling older adults with dementia by visiting nurses, we conducted semi-structured interviews with 10 visiting nurses and analyzed their responses qualitatively and inductively. As a result, 24 subcategories and 8 categories were identified. Visiting nurses were found to conduct pain assessment and assessment based on behavioral changes in usual daily life because of characteristics of health assessment in home care, in which the goal is to comprehensively support clients as living people, in addition to standard pain management of older people with dementia. The results suggest that the viewpoint to integrate information from other professionals and family members and assess daily life comprehensively is important, and some mechanism to facilitate multidisciplinary information sharing is required. When visiting nurses were unsure of whether a patient is in pain, they evaluated the patient’s pain on the basis of behavioral changes in his or her normal daily life after medication or nondrug treatment. A nationwide survey is necessary for further clarification.

Objective: To create an authorized translation of the “definition of palliative care” according to WHO using the Delphi method. Methods: Through a palliative care association council (hereafter referred to as the “council”) composed of 18 academic organizations, this research aimed to create an authorized translation draft and develop a consensus for it using the Delphi method according to 54 experts, three from each organization. The main clause and nine subordinate clauses of the document were evaluated from “not at all appropriate” (1 point) to “completely appropriate” (9 points). The standard for consensus was if the median was 7 points or above, or if there was a difference of 5 points or less between the maximum and minimum. The council created an authorized translation in light of the consensus status. Results: Three rounds of the Delphi method were performed; the response rates were 100%, 93%, and 91% respectively. As 30% of the clauses reached the predetermined standard for consensus, the council discussed and considered, established an authorized translation draft, and made a decision upon public comment from each academic organization. Conclusion: Academic organizations associated with palliative care jointly created an authorized translation for the “definition of palliative care” according to WHO.

This study aimed to clarify financial issues of cancer patients and their families through consultation records. At four sites, 125 reports of individual consultations with regard to employment and finances through financial planner and certified social insurance labor consultant were analyzed using text mining. The mean age of participants was 54.0 ± 10.1 years, and 70 were female (56.0%). The most frequent five words and their co-occurring words were as follows: “month” (104 times; co-occurring words: “leave of absence” and “year”), “injury and sickness allowance” (93 times; co-occurring words: “receive” and “leave of absence”), “current” (72 times; co-occurring words: “receive” and “income”), “work” (68 times; co-occurring words: “contents” and “continue”), and “treatment” (62 times; co-occurring words: “living” and “income”). Our result indicated that participants felt anxious about finances and impact on their life associated with cancer treatment. In addition, cancer patients and their families received advice about timing, ways, and choice of return to work, resigning, and continuing to work, and use of public system including injury and sickness allowance that people can use during their leave of absence from consultants.

Introduction: The current author encountered a patient with end-stage bladder cancer who developed hyperammonemia and impaired consciousness. Case: A 90-year-old man had repeated bleeding from a bladder tumor, so a urethral catheter was placed. During admission to the Palliative Care Unit, impaired consciousness and hyperammonemia were noted. Liver metastasis was not noted. Urinalysis revealed alkaluria and ammonium magnesium phosphate crystals, so production of ammonia by bacteria with the ability to hydrolyze urea was suspected. Levofloxacin was inefficacious. As a result of administration of metronidazole, however, consciousness improved, blood ammonia levels returned to normal, urine was acidic, and ammonium magnesium phosphate crystals disappeared. The bacterium with the ability to hydrolyze urea could not be identified. Discussion: In patients with advanced or end-stage bladder cancer like the current patient, ammonia produced by bacteria with the ability to hydrolyze urea can cause hyperammonemia and impaired consciousness even if the urinary tract is unobstructed.

Introduction: This study reports on a case of SAPHO syndrome in a patient in the palliative care unit who had multiple bone metastases of an unknown primary carcinoma. Case: A 74 year old male presented with broken eleventh thoracic and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed multiple lesions, which were thought to be bone metastases of a carcinoma, in the thoracic and lumbar spine. Attempts to identify the location of the primary lesion were unsuccessful. Therefore, the differential diagnosis was multiple bone metastases of an unknown primary carcinoma. The patient was transferred to the palliative care unit. The patient’s condition remained largely unchanged for several years; therefore, a second set of clinical examinations was conducted. Computed tomography revealed sternocostoclavicular hyperostosis, and there was symmetric uptake on bone scintigraphy. Further MRI studies revealed that the spinal lesions were comparatively reduced, leading to a diagnosis of SAPHO syndrome. Discussion: SAPHO syndrome is a rare, benign disease that presents as a variety of osteoarticular disorders with specific dermatoses. SAPHO syndrome is difficult to diagnose; therefore, it is important to consider it as a differential diagnosis in patients with bone lesions.

Background: Even for the emergency transportation of cancer patients in the terminal phase of the disease with a DNAR, all patients are transported while resuscitation is carried out. We examined how on-site rescue squads felt about this along with what was found therefrom. Methods: We conducted an anonymous questionnaire among 103 staff members involved in emergency activities in the area concerned. The contents included: Have you ever transported patients with a DNAR? If yes, what kind of activities did you carry out?; and If not bound by the Fire Services Act, what kind of activities would you have carried out? Results: Even if you express your DNAR order, they have no choice but to comply with the Fire Service Law. Even assuming that there is no Fire Service Law, about half of respondents responded to lifesaving treatment, but about half of them responded that they wanted to refuse transportation. Discussion: For rescue squads, a difference between resuscitation activities and transportation was observed. Lack of knowledge among those near the patient who request emergency transportation against the will of the patient is the major cause of transporting patients with a DNAR. In order to respect the will of patients, the permeation of advance care planning including decisions made by visiting physicians and the creation of advance directives and education of local residents are necessary.

Background: Cancer may have impacts on parents for child rearing. There has been few reports regarding what support is needed for them. The aim of this study is to investigate the needs of support system for cancer patients who have young children. Methods: First, we retrospectively studied records of specialized support for patients who had young children by palliative care team in National Cancer Center Hospital (NCCH) from April 2013 to September 2015. The data was collected from the NCCH electronic medical records. Next, we qualitatively classified the concerns about child-rearing of patients and their family. Results: A total of 131 (Male/Female: 41/90) cases received specialized support for patients who had young children during study period. The average age of patients was 43.3. Top three of primary sites of the patients were gastrointestinal tract, lung and breast. Approximately eighty percent of the patients were in the state of the recurrence and/or progressive cancer. The average age of their young children (n=239) was 9.6 (ages 0-17). The parents’ perceptions of child-related stressors were classified into three subcategories: 1. How to tell children about illness and treatment, 2. How to manage children’s reaction and emotion after having told them about illness, and 3. How to keep the parents’ role of child-rearing. Discussion: We found that patients who have children (age 0-17) have various types of concerns depending on their condition or age of children. Therefore, multi-disciplinary team approach for improving an effective support system was needed.