Purpose: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.

Objectives: To assess the perception of care and outcomes of end-of-life palliative care by bereaved family members to determine differences in care provided to patients with and without cancer. Methods: This cross-sectional, anonymous survey using a self-reporting questionnaire for bereaved family members was conducted online. Care was assessed using overall satisfaction score and the care evaluation scale (CES) and outcomes were assessed using good death inventory (GDI). Results: The present study included data from 118 patients with cancer and 299 patients without cancer (103, heart failure; 71, stroke; and 125, pneumonia). The overall satisfaction score was not significantly different between patients with and without cancer. Conversely, physical care score in the CES and autonomy score in the GDI were significantly lower in patients without cancer than in patients with cancer (p<0.05). Conclusion: The satisfaction with end-of-life care was comparable between the bereaved family members of patients without cancer and those of patients with cancer. However, results related to some items of CES and GDI suggest that some components of end-of-life care for patients without cancer might require attention. Not only treatment of the underlying disease but also relief of suffering is important to improve end-of-life care.

Objective: To clarify factors related to emotional instability in spouses of cancer patients receiving palliative chemotherapy. Methods: Semi-structured interviews were conducted with spouses of cancer patients receiving palliative chemotherapy, and the obtained data were qualitatively and inductively analyzed. Results: Through analysis, 9 related factors were identified: “realizing the severity of the situation when receiving an explanation of the pathological condition”, “an unclear prognosis”, “fear of losing any treatments”, “being pressed for treatment-related decision-making”, “increased daily burdens by the care”, “collapse the visions of the family future”, “communication with medical professionals”,“candid dialogues with the patient”, and “relationships with others”. Conclusion: It may be important for nurses to help families of cancer patients realistically manage their situation without excessive confusion, even when they experience emotional instability, and spend meaningful time with patients as an outcome of treatment, with an understanding of these related factors on such emotional instability.

Objective: This study aimed to reveal the prevalence and characteristics of anguish among delirious patients with advanced cancer receiving specialized palliative care services. Methods: We conducted a subanalysis of a multicenter, prospective, observational study at 14 inpatient palliative care units and 10 general wards that offered psycho-oncology consultation service in Japan. We consecutively enrolled the patients with advanced cancer who were diagnosed with delirium and prescribed antipsychotics. Palliative care specialists decided whether patients suffered from anguish or not. We assessed patients’ background and severity of delirium with the Delirium Rating Scale-Revised (DRS-R-98). Results: Of 818 enrolled patients, 99 (12.1%) suffered from anguish. We observed a significant difference in the mean age (68.9±12.6 vs. 72.1±11.2, p=0.009), prevalence of dementia (2% vs. 10.4%, p=0.005) between patients with anguish and those without anguish. Patients with anguish had lower DRS-R-98 total scores before medication than those without anguish (15.3±8.1 vs. 17.3±7.8, p=0.018), but higher severity score in lability of affect (1.2±0.8 vs 1.0±0.9, p=0.023). Conclusions: The results of this study suggested that patients with anguish tend to be younger, mostly do not have dementia, and have lower delirium severity score but higher score in lability of affect. Nevertheless, further research, investigating appropriate evaluations and medical interventions for patients with anguish is warranted.

Objective: This study investigated the association between use of sedatives in terminal cancer patients near death who were receiving home care and the home care period. Methods: We conducted a retrospective review of the medical records for 1032 cancer patients who received home palliative care from 17 specialized home care clinics between June and November 2013. We checked the use of sedatives within 48 hours before death at home, and we compared the home care period between patients with and without sedation. Results: The sedatives used were diazepam (n, %: 100, 52%), flunitrazepam (29, 15%), bromazepam (27, 14%), midazolam (26, 13%), and phenobarbital (20, 10%). The median home care period (median [quartiles]) was 26 [13, 63] days and 25 [10, 64] days (Adj p=0.79) for the patients with and without sedatives, respectively. Conclusion: Among terminal cancer patients near death receiving home care, 24% were administered sedatives, with more than half of those patients receiving diazepam. There was no association between use of sedatives and the home care period.

We report a patient, who had neuropathic pain after radiation, called “chronic post-radiation pain syndrome,” who was successfully treated by Shimbuto. The patient was a 83-year-old man, diagnosed with Stage IB non-small cell lung cancer of the left upper lobe. Although the lesion had a surgical indication, he selected radiotherapy, and stereotactic body radiotherapy was performed. A few months later, he experienced neuropathic pain in his anterolateral chest wall. Loxoprofen and acetaminophen had little effect; moreover, tramadol hydrochloride/acetaminophen combination tablets and pregabalin induced drowsiness and dizziness. He then wanted to take Kampo medicine (Japanese traditional medicine) and was observed to have susceptibility to gastrointestinal disorders and cold intolerance by Kampo diagnosis. We prescribed Shimbuto 5 g per day, along with pregabalin. After 2 months, the pain had almost disappeared and he could stop taking pregabalin. Shimbuto is usually prescribed to patients at a risk of gastrointestinal disorders, pain, numbness, and other symptoms induced by cold intolerance. Shimbuto includes the extract of processed aconite root, which is effective for pain and numbness; therefore, it might be a good option for treating neuropathic pain when we have difficulties with Western medicine.

Background: Acetaminophen, an antipyretic analgesic, is one of the main pain relief medications for cancer according to the World Health Organization guidelines. Design: A case report of a 75-year-old woman who had been taking acetaminophen to relieve cancer pain caused by recurrence after surgery for left upper-lobe cancer and multiple bone metastases. Following a formulation change, the participant experienced allergy-like symptoms. Results: After switching to a different formulation, the allergic symptoms disappeared. Conclusion: The results obtained from this case report suggest that pharmaceutical additives in the acetaminophen formulation caused the allergic reaction, and not the acetaminophen itself. The woman’s pain was successfully controlled by changing to a different type of formulation. If allergic reaction symptoms appear after taking acetaminophen, switching to a different formulation of the drug may enable the continued use of acetaminophen to treat the patient’s pain.

Tapentadol was developed from tramadol by reducing its inhibitory effects on serotonin reuptake. In the present study, tapentadol was administered to a 49-year-old female esophageal cancer patient receiving a selective serotonin reuptake inhibitor (SSRI). On the day of administration, akathisia, nausea, dizziness, and insomnia developed. On the following day, she was diagnosed with serotonin syndrome, accompanied by fever, perspiration, myoclonic jerks mainly affecting the upper limbs, tremor of the extremities, and tachycardia. The diagnosis was made using three criteria. The symptoms disappeared immediately after discontinuation of tapentadol administration and initiation of benzodiazepine treatment. In Japan, tapentadol is an opioid analgesic for cancer pain management. If it is combined with an antidepressant, follow-up care is needed in consideration of serotonin syndrome.

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat to puncture, especially in the case of little effusion space. Here we report a case of non-small cell lung cancer, 71 years old male, who was diagnosed in 2012 and had malignant pericardial effusion as a post-operative recurrence in June 2018. After several chemotherapy regimens, he suffered from dyspnea on effort due to increasing pericardial effusion. We performed pericardial drainage, but 2 months later pericardial effusion had increased again. The need of repeating of pericardial drainage was estimated, so we placed subcutaneously placed port system into his pericardial space. Thereafter, we drained pericardial effusion through it on demand for his dyspnea. Gradually his circulatory status had been exacerbated and he died on 36th day after the procedure. In the case of malignant pericardial effusion, the subcutaneously placed port system may be useful because repeated aspiration can be done by single procedure of pericardial puncture. It may keep quality of life of patients and more cases should be experienced and assessed.

Under the Cancer Control Act, the government has developed a comprehensive cancer strategy, which aims to promote basic awareness about palliative care among physicians involved in cancer care. In 2008, “palliative care training for physicians involved in cancer” was held for the purpose of acquiring basic palliative care. Since 2009, the Palliative care Subcommittee of the Osaka Prefectural Cancer medical treatment cooperation meeting adjusted the schedule of the palliative care training in Osaka Prefecture, and established an instructor registration and dispatch adjustment system. In the 10-year period, we supported a total of 357 palliative care training sessions, and as of March 2018, 8416 physicians and 2674 staff members completed the palliative care training session. In Osaka Prefecture, the instructors who completed the training program for basic education in palliative care and psycho-oncology were invited to cooperate each year, and 142 physical physicians and 64 psychiatric physicians were registered, and five medical doctors and two psychiatric doctors were dispatched to each palliative care training session. The lecturer dispatch system was held smoothly by the palliative care training in Osaka Prefecture, and it seems to have contributed to the increase in the number of trainees who completed the training.

Background: Adolescents and young adults (AYA) with cancer go through various life events during their illness trajectory, and there is often insufficient information on their diseases due to their rarity. Few chances are available for AYA patients to meet and share information with each other. Therefore, at the National Cancer Center Hospital in Japan we hold AYA Hiroba, a monthly get-together for AYA patients to communicate with each other. This study investigated satisfaction and effect with the activity. Methods: We have held the AYA Hiroba activity once a month since May 2016. We asked participants to complete a questionnaire at each session.Results: We held the activity 33 times between May 2016 and May 2019. A total of 130 patients participated, and 97 of them completed the questionnaire, including providing demographic data, since October 2017. The respondent demographics were as follows: sex (male/female), 38/59; median age, 29 years (range 14–39 years); outpatients/inpatients, 31/66; number of sessions attended (1/≥2), 42/55; and cancer type (sarcoma/malignant lymphoma/brain tumor/germ cell tumor/leukemia/melanoma/breast cancer/neuroblastoma/Wilms tumor/lung cancer/cervical cancer/nasopharyngeal cancer/tongue cancer/blank), 45/11/9/7/6/5/3/3/2/1/1/1/1/2). Many attendees perceived the activity favorably: “It was very satisfying” (61.7%), and “It was very helpful” (65%). The feedback was classified into three categories: “interaction with the same generation”, “diversion”, and “getting information”. Discussion: AYA patients have a great need to communicate with each other, and the feedback suggests that AYA Hiroba would be effective in interaction with the same generation, diversion and getting information. Most participants were very satisfied with the program.