In this study, we clarify the experiences of students through providing nursing care for end-of-life cancer patients and examine the guidance of clinical practice necessary to link the experiences with the result of learning. We conduct interview survey of 15 nursing third graders who take care of terminal older cancer patients in clinical practice in gerontological nursing. The students’ experience was classified into six categories ; “Repentance for doing nothing”, “Involvement actively with patients”, “Awareness of life preciousness”, “Concentration on daily nursing”, “Repentance for insufficient care”, “Respect for patients’ own lives”. The student’s experience focused on the terminal stage situation, and it was an experience to learn the importance of making them live with dignity, reflecting on their own care. It was suggested that widening students’ view of patients’ individual lives was quite useful to consider terminal care based on the characteristics of people.

Introduction: The diagnosis of cancer-related neuropathic pain is often difficult for non-pain medicine specialists. We examined whether a Japanese version of a neuropathic pain screening questionnaire (Japan-Q), which was developed for chronic pain, is appropriate for screening cancer-related neuropathic pain. Methods: Our palliative care team screened 104 patients from May 2014 to December 2015 and compared total points of the Japan-Q with diagnosis of the type of cancer pain by specialized pain clinicians. Validity was evaluated using a receiver operating characteristic (ROC) curve. Results: The area under the ROC curve in terms of the total score, sensitivity, and specificity for the Japan Q was 0.82, which indicated a moderate level of diagnostic accuracy. A cut-off value of 3 points was shown to be best (sensitivity: 79%, specificity: 82%). When a cut-off value of 9 points was used as the diagnostic criterion for neuropathic pain, there was greatly reduced sensitivity (sensitivity: 40%, specificity: 97%). Conclusion: Although the Japan-Q shows moderate diagnostic accuracy related to cancer pain, the cut-off value for this tool is lower than that for chronic pain. Cancer-related neuropathic pain should be suspected with a total score of 3 or more in the Japan-Q.

Purpose: Patients with hematologic malignancies use palliative care units less frequently than those with solid tumors. The purpose of this study was to clarify the clinical characteristics of patients with hematologic malignancies who had been admitted to a palliative care unit. Methods: The clinical records of patients with cancer who died in our palliative care unit between April 2014 and March 2019 were reviewed retrospectively. We compared the severity of symptoms, the prevalence of symptoms, and the time from the last cancer-directed therapy to death between hematologic and solid tumor patients. Results: We identified 560 cancer patients, 56 (10%) of whom had hematologic malignancies. The overall symptom severity was similar in both groups of patients. Hematologic patients had higher rates of clinically significant fatigue (52% vs. 32%; p=0.004) and fever (45% vs. 21%; p=0.0004) than solid tumor patients. The median interval from the last cancer-directed therapy to death was 69.0 days for patients with hematologic malignancies versus 94.5 days for those with solid tumors (p=0.031). Conclusions: Patients with hematologic malignancies admitted to the palliative care unit have similar symptom severity at the end of life as patients with solid tumors, suggesting similar hospice care needs.

Objectives: This study aimed to clarify the present system of palliative care at general hospitals, and to examine the factors contributing to the opioid consumption. Methods: We surveyed the palliative care system using a self-administered questionnaire, which was mailed to 37 general hospitals in Southern and Southwestern wards, Tokyo. Multiple regression analyses were used to identify the associations between explanatory variables and the opioid consumption. Results: Valid responses were obtained from 18 hospitals (response rate: 48.6%). 35% of the general hospitals didn’t have a palliative care team and most hospitals had no specialists. In multivariate analyses, factors associated with the opioid consumption were pharmacists with speciality of pharmaceutical palliative care, physicians joined the palliative care education program based on the Cancer Control Act of Japan, and the number of physicians’ correct answers of questions regarding palliative care. Conclusion: The survey showed that the higher consumption of opioids is significantly associated with the number of health care workers who have knowledge of palliative care. Our study suggested that the arrangement of palliative care experts might decrease the differences in the opioid consumption between general hospitals.

Although palliative sedation therapy (PST) is considered to alleviate intolerable and refractory symptoms in dying patients with advanced cancer, there have been few studies regarding the situation of tertiary cancer center. We conducted a retrospective survey of the medical records of the patients who died between April 2015 and March 2016 at the National Cancer Center Hospital in Japan. PST was conducted in 75 out of 431 patients (17.4%). The patient demographics were as follows: sex (male/female), 48/27; median age, 61 years (range 5-83; 11 patients (14.7%) were aged under 39 years); and primary sites were lung, 18 (24.7%)/ pancreas, 11 (14.7%)/ hematopoietic organs, 11 (14.7%)/ bones and soft tissues, 8 (10.7%)/ and the others, 27 (36.0%). The main target symptoms for PST were dyspnea (38, 50.7%) and delirium (30, 40.0%). The most commonly used sedative agent was midazolam (72, 96.0%). Continuous deep sedation was intended in 61 patients (81.3%) at the death. Median survival from the start of PST were 2 days (range 0-54). The differences between palliative care team (PCT) intervention group and control group were lower age (58 vs. 62.5, P=0.048) and uniformity of initial midazolam dose (5-12 vs. 9.6-25.2 mg/day). Distinctive feature in this study was large proportion of adolescent and young adult patients with rare cancers. PCT might have different approaches to sedation in comparison to non-PCT medical staffs.

We report that the discontinuation of haloperidol during subcutaneous infusion therapy with hydromorphone citrate led to the improvement of subcutaneous induration. A 70-year-old female was admitted to our palliative care unit with neck pain. She had neck lymph node metastasis from carcinoma of unknown origin. As subcutaneous infusion of hydromorphone citrate caused nausea, we administered haloperidol with hydromorphone citrate in normal saline. The infusion sites after 4, 9, and 11 days were changed because of subcutaneous induration, which we considered to be caused by haloperidol. After discontinuation of haloperidol, induration at the infusion site was not observed.

Opioids are known to cause dysfunction of the sphincter of Oddi. However, there are no reports on acute cholangitis due to opioid-induced dysfunction of the sphincter of Oddi. A 75-year-old woman with breast cancer, who had been prescribed oxycodone for lower abdominal pain due to unknown causes for 8 years, suddenly developed hypochondriac pain. We diagnosed the patient as having acute cholangitis and performed endoscopic retrograde pancreatography and technetium hepatobiliary iminodiacetic acid scan. The cause of acute cholangitis was considered to be opioid-induced dysfunction of the sphincter of Oddi. Six and nine days after admission, endoscopic sphincterotomy was performed, after which her upper abdominal pain resolved. Opioids increase biliary pressure and delay bile flow into the duodenum in patients after cholecystectomy. However, the actual clinical outcomes of using opioids for acute cholangitis and pancreatitis remain unknown. Thus, although opioid-induced dysfunction of the sphincter of Oddi is uncommon, it should be assessed in patients who are prescribed opioids.