Objectives: The study purpose was to examine quality-of-life (QOL) of pediatric cancer patients at end-of-life and related factors using a QOL proxy rating scale from the nurse’s perspective. Methods: We conducted a survey in October 2015−February 2016. The subjects to be surveyed were nurses who were primarily in charge of patients with childhood cancer at end-of-life. We investigated 22 items of the Good Death Inventory for Pediatrics (GDI-P) and their related factors. Results: In total, 53 proxy evaluate questionnaires were completed from 18 centers. Among the eight factors of GDI-P, “Relief from physical and psychological suffering” was the lowest. The total score of GDI-P was positively correlated with the structure and process of care (r=0.58). Although there was a bias in the number of cases, in the case of the place of death was the intensive care unit, the total score of GDI-P was lower than home and the general ward. Conclusions: It was suggested that the top priority in improving QOL was relief from suffering and the structure and process of care were related to QOL.

Objective: The aim of this study is to elaborate on the nutritional intervention in a multimodal intervention (the NEXTAC-ONE program) for the elderly with advanced cancer and to evaluate its tolerability Methods: We prospectively recruited patients aged ≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three nutritional intervention were planned in 8-week study period. The nutritional counseling consists of standard nutritional advice, evaluation and support for nutrition impact symptom, and evaluation and support for eating-related distress and food environment problems. We also provide the oral nutritional supplements rich in Branched Chain Amino Acids (BCAA). Results: 29 patients (96%) of a total of 30 study registrants participated in all three nutrition interventions. Median proportion of days in which patients recorded a nutritional diary was 90%. Median consumption of supplements was 99 %. There was no adverse event associated with nutritional intervention. Conclusions: Our nutritional intervention program showed an excellent compliance in the elderly with advanced cancer patients, and our data indicated a potential protective effect on nutritional deterioration.

Objective: This study aimed to investigate self-perceived burden (SPB) on families experienced by patients with cancer undergoing outpatient chemotherapy, and factors that affect SPB. Methods: Self-administered questionnaires were sent to patients with cancer in 17 designated cancer care hospitals. Of 1,981 effective responses (response rate 54.7%), 600 patients with cancer undergoing outpatient chemotherapy were included in this study. Results: More than 85% of participants reported SPB on their families. Multiple logistic regression analyses revealed independent physical and social factors that influenced the SPB on families among patients with cancer undergoing outpatient chemotherapy. Physical factor was recurrent or metastasized. Social factors were 40s or younger; living with families; marital history; worries of work or financial problems; worries of interpersonal relationship with families and others. Discussion and Implications: Our findings suggest that medical staff may need to offer psychological care according to patient’s cancer progression and support according to their social background to reduce SPB on their families.

Purpose: Naldemedine is a peripheral µ-opioid receptor antagonist, including the treatment of opioid-induced constipation (OIC) . However, diarrhea is known as its side effect. We conducted a study focusing on the administration period of opioid analgesics before the start of naldemedine to clear predictors of diarrhea due to Naldemedine. Method: All data were retrospectively collected from the electronic medical record system. We investigated patients who initially administrated naldemedine at Nagasaki University Hospital from June 1 2017 to March 31 2019. Result: One hundred thirty-two patients were subject of investigation. The incidence of diarrhea was 25.0%. The result of the multivariate analysis showed that significant predictors of diarrhea were associated with the opioid analgesics usage period longer than 7 days before naldemedine initiation (odds ratio: 3.76, 95% confidence interval: 1.53-9.20, p=0.004). Discussion: When naldemedine was used for OIC, diarrhea may be avoided by using within 7 days after opioid analgesics.

Objective: This study aimed to reveal the psychological adjustment process to getting close to death of palliative care staff focusing on views on death and time perspectives. Method: Semi-structured interviews were conducted with 10 palliative care staff. The obtained data analyzed using TEM (Trajectory Equifinality Model). Results: palliative care staffs worked maintaining mental health by changing the way they perceive death in palliative care careers. In addition, it is speculated that the environment of palliative care where death is familiar extends the perspective to the past, present and future, and promotes the formation of an adaptive time perspective. Furthermore, it was inferred that such an environment would increase awareness to send a better life. Conclusion: It is necessary to understand and to promote positive meaning of view on death of the staff. In addition, it is thought that taking time perspective into palliative care may also lead an awareness of the engagement as a source of human growth and change a consciousness of daily care. Therefore it can be said that taking time perspective into palliative care is very beneficial.

To decide the policy to promote palliative care properly, a new questionnaire has been added to Patient’s behavior survey to assess Quality of Life (QOL) of inpatients and outpatients in Japan. The aim of this study was to survey QOL score of general population in Japan by using a questionnaire of patient’s behavior survey. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. A total of 978 (41.1%) questionnaires were analyzed, and reference data of QOL score weighted by the national standard value of sex-age group population were calculated. Correlation coefficients were calculated between QOL score and SF-8TM, Patient Health Questionnaire-9 (PHQ-9), Eastern Cooperative Oncology Group Performance Status (ECOG), Memorial Symptom Assessment Scale (MSAS) score. In addition, sociodemographic factors related to QOL score were evaluated. From the perspectives of public health and administrative policy, the results of this survey will provide important basic data to evaluate patient’s behavior survey broadly and continuously with the goal of establishing a palliative care system in Japan.

Objective: This study evaluated the effectiveness of an end-of-life care simulation as a way to improve nursing students’ resilience. Methods: In total, 61 baccalaureate nursing students were randomly assigned to control or education groups. In this randomized controlled study on an end-of-life care simulation, resilience was measured at baseline, and after the simulation. Result: At the baseline, the two groups showed no statistical differences in their resilience scores. However, the total score, and scores for the factors “I am”, “I have”, and “I will/ do” were significantly higher for the education group than the control group in the post-test. The total scores and three factor scores within the education group were also significantly higher in the post-test than at baseline, but in the control group only the “I am” factor significantly increased over time. Conclusion: The end-of-life care simulation scenario showed the potential to increase the resilience of participants, especially their ability to build trusting relationships with others and expand their network, and to set goals and grow toward them.

This retrospective study investigated the incidence of subcutaneous induration induced by hydromorphone citrate (HM) and haloperidol (HPD). From September 2018 to December 2019, 75 consecutive patients admitted to our palliative care unit were enrolled. A total of 177 subcutaneous injection sight reactions were assessed from the study initiation to data collection. Patients were then classified into three groups: group A, administered HM + normal saline (NS); group B, administered HM + HPD + NS; and group C, administered HM + HPD + 5% glucose water (Glu). Subcutaneous indurations were observed 29 times at the median of 71.0 (27–151) h. The incidence rates of subcutaneous induration were 4.7% (4/86), 39.1% (18/46), and 15.6% (7/45) in groups A, B, and C, respectively. A significant difference in this rate was observed between groups A and B and between groups B and C. The incidence rates of subcutaneous induration were low in the HM + NS group, but it rose by the addition of haloperidol significantly. Changing from NS to Glu as dilution liquid for HM + HPD decreased subcutaneous induration incidence.

We report a case of refractory cancer pain that was successfully treated with opioid switching by adding methadone to the preceding opioid. A 38-year-old man had severe epigastric pain and back pain because of paraaortic lymph node metastasis of a gastroesophageal junctional carcinoma. His pain was treated with continuous intravenous morphine administration and the frequent use of a rescue dose. When the morphine dose was increased, respiratory depression developed; thus, his pain was considered refractory to the morphine, and methadone was added on. The pain was relieved after initiating methadone, and the frequency of the rescue dose was markedly decreased. The methadone dose was gradually increased in parallel, and the morphine dose was reduced and finally discontinued. No methadone-induced side effects were noted, and the patient was discharged with good analgesia. In our case, adding methadone without decreasing the preceding opioid dose under strict monitoring made it possible to stably switch the opioid without increasing pain.

Background: We experienced two cases where fentanyl relieved pregnant women of their cancer pain. Case 1: A pain in the lower back of a 30-year-old woman since the 30th week of her pregnancy for multiple myeloma. We started fentanyl continuous intravenous infusion on the first day of the 34th week and gradually increased the dosage to 32 μg/h. Elective cesarean section was performed on the 1st day of week 36. The child was born without problems. Case 2: A 34-year-old woman was diagnosed with stomach cancer in the 22nd week of her pregnancy. Fracture on the twelfth thoracic vertebra was also found. Continuous-subcutaneous-infusion of fentanyl was started and the dosage was escalated to 24 μg/h , which reduced her pain. Chemotherapy was effective for her cancer and did not affect the fetus. At week 34, elective cesarean section was carried out. Because the child presented cyanosis immediately after birth, tracheal intubation was performed, but extubated on the next day without problem. Conclusion: Fentanyl was found to be effective for reducing cancer pain in the two cases. Although the existence of causal relationship is unknown, cyanosis was observed in one case.

Stiff-person syndrome (SPS) is an extremely rare disease that is characterised by progressive rigidity and muscle spasms affecting the axial and limb muscles and is difficult to diagnose. In SPS, autoantibodies such as anti-GAD antibody or anti-amphiphysin antibody may be proved, and it is speculated that SPS is GABAergic neurons disorder with the central nervous system due to these antibodies. We report a case of advanced breast cancer with a paraneoplastic SPS. Case: A 52-year-old woman was diagnosed with advanced breast cancer with bilateral multiple lung metastases, bilateral cancerous pleurisy, multiple liver metastases, cancerous peritonitis, and bilateral ovarian metastases. Anti-cancer treatment was not indicated due to poor condition, and oxygenation and pleural drainage and ascites drainage were performed in the palliative care unit. A series of symptoms due to muscle rigidity progressed rapidly which initially manifested as dysphagia, then stiffness of the upper extremities and locomotive disability. So she was diagnosed as paraneoplastic SPS by a neurologist. Despite the partial efficacy of diazepam, it was difficult to increase dosage due to sedation.

Background: Hydromorphone is an analogue of morphine used in the treatment of cancer-related pain. There have been few studies that have evaluated the analgesic effect upon transition from hydromorphone injections. The aim of this study was to evaluate the conversion ratio between injection and oral preparation. Methods: We conducted a retrospective chart study of consecutive patients who were admitted to our hospital between July 2018 and December 2019. Results: In six patients, when the conversion ratio from hydromorphone injection to oral was changed at a 1:5 conversion ratio, three patients obtained adequate analgesic effects, the analgesic effect was insufficient in one case and an increased dose was required. Significant drowsiness appeared in two patients who required a decrease in dose. Conclusions: In converting from hydromorphone injections to oral preparations, it is necessary to carefully monitor the analgesic effect and adverse events and adjust the dosage for each case regardless of the conversion ratio.

Tumor lysis syndrome (TLS) is a metabolic disorder that is caused by acute lysis of massive tumor cells. We report a case with opioids-related severe respiratory depression induced by TLS. A 39-year-old man received chemotherapy for mycosis fungoides. Two hours after administration of chemotherapeutic agents, his renal function worsened, and he was diagnosed with TLS by laboratory and clinical findings. Moreover, he showed severe respiratory depression and pinpoint pupils, and become drowsy. These symptoms were attributed to oxycodone that had been administered to treat his tumor-related cutaneous pain, and were improved by injection of anti-opioids agent naloxone. In this case, we consider that the clearance of oxycodone was disrupted by renal dysfunction caused by TLS, leading to enhancement of the effects of oxycodone.

Introduction: Although spiritual care is one of the challenges of palliative care, structured interventions are limited. We report on the original development of the Dignity Individual Music Therapy Program (DMT) incorporating the elements of Dignity Therapy (DT) for spiritual care. Program: Developed by a research group including a music therapist based on the experience of DT. Procedure: First, the patient selects important songs based on questions such as "When did you live the most in your life? Are there any songs that remind you of those days?" Next, a music therapist plays the music on a piano in a hospital room (individual concert). Encourage the patient to talk freely about their thoughts and life episodes after the performance. Discussion: Patients who have performed DMT have been very well received. Because it is a structured program, it can be implemented in various places. The utility and feasibility of spiritual care will be investigated.