Objective: To examine the trajectory of activities of daily living (ADL) in cancer patients from 6 weeks before death using the Functional Independence Measure (FIM). Method: This study was a retrospective observational study. The participants were cancer patients aged 18 years or older who died and were discharged from the palliative care unit in Tsurumaki-onsen Hospital. Six weeks of FIM data were collected from the patients’ medical records from 6 weeks before death to the time immediately before death (week 0). Results: Fifty-five participants were included in the study. FIM scores declined from 55 points at 6 weeks before death to 25 points immediately before death. Functional independence was higher for cognitive items on the FIM than for motor items, and both cognitive and motor functioning significantly declined just before death. Within the motor subscale, the patients were more independent with regard to eating, grooming, and bladder management compared to other activities until just before death. Within the cognitive subscale, the patients showed greater independence with regard to expression and social interaction. Discussion: A support for ADL needs to be considered to assist out-of bed activities in a safe and comfort manner until two weeks before death. Patients’ activities on the bed can also be continued for independence until just before death.

Purpose: We investigated into the effect of religious involvement in nursing homes on users, facility staff, and families to explore the clinical significance of the religious involvement from the viewpoint of nursing care workers. Method: A questionnaire survey and a semi-structured interviews were conducted with 12 nursing care staff at a special nursing home for the elderly. Result: Eight factors such as “extraordinariness” caused five effects such as “positive changes in mental state in everyday situations” for the users. Two factors such as “development of awareness of religion” had two effects such as “changes in personal view of religion” for the care staff. Also, a factor of “caring for the users on their deathbeds” had an effect of the “opportunity of mental care” for the families of the users. Conclusion: These findings suggest that the religious involvement may be beneficial not only to users but also to facility staff and families of the users.

Purpose: To understand the experiences of and difficulties faced by palliative care unit nurses when caring for refractory cachexia. Method: Palliative care nurses completed anonymous self-report postal questionnaires. Factor and multiple regression analyses were then carried out to interpret results. Results: A total of, 169 valid questionnaire responses were received and analyzed. Six factors were identified relating to the difficulties experienced by nurses when caring for refractory cachexia. [A feeling of helplessness and conflict among patients and families faced with decline and death] was considered the most difficult factor experienced by nurses, and typically other difficulties were considered more prominent when this factor was present. [The approach of assessment and perception of refractory cachexia care] differed according to the nurse’s years of experience, degree of involvement in patient care, and learning opportunities previously encountered. [Nurses tended to cope] more easily with the challenges faced if they had been assigned for >3 years. Conclusion: Six factors were identified as difficulties associated with the care of refractory cachexia. These findings suggest the need for thoughtful dialog with patients and their families and the importance of further educational support for nurses.

This study aimed to reveal the perceptions of nurses involved in patient decision-making regarding palliative sedation. Semi-structured interviews were conducted with six nurses working at hospices, and the data were qualitatively and descriptively analyzed. Nurses’ perception regarding “difficulties involved in the decision-making process,” “stance of placing emphasis on patients’ preferences,” and “coping behaviors for participating in the decision-making process” were identified. The nurses had difficulties associated with concerns about making patients conscious of death and carried a heavy burden, and it was suggested that they find it difficult to explain sedation or confirm patients’ preferences. On the other hand, the nurses relied on their moral principles to make judgments, showing that they try to emphasize patients’ preferences. Multidisciplinary discussions are needed to provide psychological support for nurses involved in patient decision-making on palliative sedation. In terms of the educational aspect, the need for experiences was cited, suggesting that it is necessary to educate nurses through hands-on activities such as role-playing exercises concerning making decisions about sedation.

Current evidence for the usefulness of prophylactic antiemetic drugs in opioid-induced nausea and vomiting (OINV) in cancer patients receiving opioid analgesics is limited. Further, antiemetic prophylaxis is not considered necessary in the Guideline for Cancer Pain Management by the Japanese Society of Palliative Medicine. However, prevention of side effects such as OINV is important when opioid analgesics are administered for adequate pain management and to maintain adherence. Cancer patients expect us to study factors affecting OINV and effective prophylactic measures for the condition. We retrospectively analyzed electronic records in our hospital. We found that female sex and the use of prophylactic antiemetics, chemotherapeutic agents, and steroids were statistically significant factors associated with opioid-induced nausea, and that female sex and radiation therapy were significant factors associated with opioid-induced vomiting. Especially in females, the frequency of nausea was significantly reduced in the group that received chemotherapy with antiemetics on the same day of receiving opioid analgesics, compared to the groups that did not receive chemotherapy, or that did not receive antiemetics but received chemotherapy. These results suggest that, especially in females, administering chemotherapy along with antiemetics on the same day may be one possible prophylactic measure for OINV.

Objective: To investigate the current state of awareness and practice among hospital staff in advance care planning (ACP). Methods: A total of 782 hospital staff workers were administered an anonymous questionnaire. Results: Among the participants, 27.7% answered “I have discussed the will of end-of-life care in family.” and 11.0% answered “I have discussed the surrogate decision maker.” Moreover, only 1.1% of the respondents answered “I have made document of end-of-life care in family.” Conclusion: The awareness and practice among hospital staff in ACP is still developing, suggesting the need for more knowledge and experience.

Purpose: To clarify current status of nurses in support of children with parents with cancer in Akita Prefecture. Method: Questionnaire surveys were administered on nurses in Akita prefecture. Their experiences, educational backgrounds, and ability to recognize the need for support were examined. Descriptive statistics were used for the attributes, and chi-square test or Fisher’s exact Test or Wilcoxon rank sum test was used to examine the relationship between the support experience and the attributes (p<0.05). The contents of their open comments were then analyzed using a qualitative integration method. Results: Responses were obtained from 141 nurses at 10 facilities (collection rate: 43.9%). Of the 141 nurses, 135 (96%) recognized the necessity of support for children, and 28 (20%) already had experience supporting them. The contents of support were [direct support for children] [support for children through parents] [support through coordination and coordination with resources]. Most apparent difficulties in support were “Intervene for children” and “to have a connection with children”. Conclusion: The results indicate that nurses recognize that children need support. However, they lack experience in providing such support. It is necessary to enhance support by learning support methods and sharing information with other occupations. Support from parents is important when children cannot be met.

Fentanyl buccal tablets place the tablet at the buccal site (above a rear molar, between the upper cheek and gum) and wait until it dissolves, but some patients may not be able to retain it due to defects of the maxillary molars. The aim of this study was to evaluate the effectiveness and safety of fentanyl buccal tablets when they were used outside the buccal site. Seven patients were treated with fentanyl buccal tablets outside the buccal site. For each of 5 episodes in which effective dose was identified, were investigated to average pain intensity assessed on a 0 to 10 numerical rating scale at 30 min postadministration and reduction in pain intensity of more than 33%. Pain intensity significantly decreased at 30 min postadministration in 5 patients with effective doses identified (p<0.001). In 92.0% of episodes treated, there was a reduction in pain intensity of more than 33%. Adverse events were somnolence and nausea with mild. However, these effects did not result in discontinuation of medication. Our findings suggested that fentanyl buccal tablets can be used effectively and safely even when patients used outside the buccal site.

Introduction: Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma. Patients with IVLBCL frequently have neurological symptoms associated with cerebrovascular infarction or central nervous system involvement of malignant lymphoma. Case: A 67-year-old man consulted the Department of Hematology at our hospital because of fever of unknown origin, anemia and increased serum lactate dehydrogenase. Although IVLBCL was strongly suspected, no lymphoma cells were found by multiple bone marrow aspirations and skin biopsies. Two months later, he developed hyperactive delirium, which was difficult to manage using antipsychotic agents. Brain MRI revealed multiple hyper-intense infarct-like lesions on diffusion-weighted images. After assessment of bone marrow aspiration and skin biopsies, he was administered an enough dose of prednisolone to manage malignant lymphoma. Hyperactive delirium rapidly improved. Discussion: In patients with IVLBCL, corticosteroids may be useful to manage hyperactive delirium due to cerebrovascular infarction or central nervous system involvement of IVLBCL.

Glucocorticoids are one of the key drugs used in palliative therapy. They have several palliative effects. However, aside from these effects, glucocorticoids have anti-tumor effects on lymphoid malignancies. In particular, for patients with lymphoid malignancy in the terminal stage of the disease, this medical modality can produce both symptomatic relief and anti-tumor effects without serious side effects. This article presents two impressive cases of patients with terminal lymphoid malignancy treated with glucocorticoids, who showed survival advantages and improved quality of life.

Background: In the end stage of malignant bone and soft tissue tumors with lung metastasis, it is often necessary to relieve symptoms of dyspnea due to tumor enlargement and carcinomatous lymphangitis. We report a case in which nasal continuous positive airway pressure (nasal CPAP) was effective as a palliative treatment. Case: A 66-year-old male underwent wide resection with a diagnosis soft tissue sarcoma of right femur. Four years after surgery, he was hospitalized for hilar lymph node metastasis, multiple bone metastases, and carcinomatous lymphangitis. He was treated with nasal CPAP for dyspnea, and communication was possible until the day before his death. Discussion: For end-stage respiratory symptoms, medication therapy such as morphine or steroids is often used for palliation, but often symptoms are not sufficiently improved. Nasal CPAP might be a useful treatment for palliation for rapidly progressing respiratory failure.

Integrated Distress Activity Score (IDAS) was developed in order to evaluate both positive and negative aspects of patient’s conditions throughout hospitalization. IDAS were evaluated by nurses everyday and when patients continued to have IDAS less than or equal to zero, we used this tool for determining continuous deep sedation. From 2013-2017, 1306 patients were enrolled in the study. The average rate of continuous deep sedation in the PCU was 1.2%(16 patients). Dyspnea was the most common condition (62.5%, 10 patients), followed by delirium (37.5%, 6 patients).The average days that took to decide for sedation (from the day when IDAS was less than or equal to zero), was 3.7 days. This study suggested that IDAS could be a useful tool for determining continuous deep sedation.