The aim of this study was to clarify the experience of recurrent/advanced cancer patients receiving outpatient cancer rehabilitation and evaluate true endpoints of cancer rehabilitation. The study was conducted by semi-structured interviews of 13 recurrent/advanced patients undergoing cancer rehabilitation during cancer chemotherapy. Six categories were extracted: [Finding the physical condition suitable for me] [Being unable to find movements that I can effectively utilize myself] [Being able to continue normal everyday life] [Showing people around me that I can still move] [Having fun actively moving my body] [Gives meaning to my present “living”]. Cancer rehabilitation is considered to give patients with recurrent/advanced cancer a chance to adapt to their present predicament by helping them re-establish the meaning, value, and objective of living. These results suggest that acquiring mastery can be a new endpoint of cancer rehabilitation.

Objective: This study aimed to investigate the feasibility of a patient registry system for assessing PCT (palliative care team) by PRO (Patient-reported outcome) in Japan. Methods: We operated a patient registry system with electronic data collection at eight hospitals in 2021 in Japan. We consecutively included newly referred patients for a month and followed up with them for a month. IPOS or ESAS obtained as PRO at the start of the intervention, three days later, and every week after. The primary endpoint was the response rate to the symptom rating scale by patients and providers. Results: 318 patients were enrolled. The patient response rate was 59.1% at intervention and 37.0% after intervention, and the medical provider response rate was 98.4% at intervention and 70.3% after intervention. Interviews with PCT members indicated that participants required support to input PRO responses required support and paper questionnaire was better and that managing the survey date and overall management was burdensome. Discussion: Although only about half of the patients were able to respond to the PRO, this was the same level as in previous studies. The system and its operation method have many problems. We found that improvements such as reducing items and making the patient interviews paper-based are necessary to expand the system nationwide.

Objective: This study aimed to identify factors associated with fatigue in patients with hematological malignancies undergoing chemotherapy. Method: A total of 90 patients with hematological malignancies undergoing chemotherapy were enrolled in this study. Simple regression analysis was performed using total, physical, emotional, and cognitive fatigue as dependent variables. On the other hand, the patient’s sex, age, blood test findings, physical function, activities of daily living (ADL), performance status, presence or absence of anxiety or depression, physical symptoms, and nutritional status were used as independent variables. Multiple regression analysis was conducted with the items that showed significant differences in the simple regression analysis as independent variables. Results: Multiple regression analysis with total fatigue as the dependent variable identified depression as an associated factor. Additionally, physical fatigue was noted to be associated with pain and depression, while emotional fatigue was reported to be associated with ADL and depression. Conclusion: Our results suggest that patients with hematological malignancies who have symptoms of fatigue should be managed taking in consideration possible causes of their fatigue, such as depression, pain, and ADL.

When continuous subcutaneous injection of opioid analgesics is initiated for patients in the terminal stages of cancer who are unable to take oral medication, Haloperidol is widely used in combination to prevent nausea and vomiting. However, Haloperidol carries the risk of skin damage at the site of subcutaneous injection. Therefore, we tried to use Blonanserin patch for the prevention of nausea and vomiting during continuous subcutaneous injection of Hydromorphone hydrochloride. In the present study, we retrospectively evaluated patients who had no history of opioid analgesic use, no concomitant use of other antiemetic drugs or antipsychotics, and who were followed up for at least 1 week. In the 5 patients who used Blonanserin patch, no nausea or vomiting occurred, and there were no skin lesions at the site of Blonanserin patch application or subcutaneous injection. In 5 cases of Haloperidol with continuous subcutaneous injection, 1 patient had nausea, 2 had skin lesions at the subcutaneous puncture site. Blonanserin patch seemed to be an option for the prevention of nausea and vomiting during continuous subcutaneous injection of Hydromorphone hydrochloride in end-stage cancer patients who were hospitalized in a palliative care unit and were unable to take oral medication.

Purpose: To clarify staff awareness and the current status of facilities regarding end-of-life care and the planning for severely disabled children and adults. Methods: A questionnaire survey on ACP was conducted on all 466 staff members of a residential facility for children with medical disabilities. Results: The response rate was 77.0%; 20.2% of direct support staff and 50.9% of indirect support staff answered that they had never heard of ACP (or life conferences). The respondents had experienced discussions with the patient and family members about medical treatment and care in the last stage of life was 27.1%. The content of the discussions was more often about the family's values and wishes than about the patient's values and intentions, and the timing of the start of the discussions was often when death was approaching .More than 70% of the direct supporters wished to participate in ACP, discussions, and they wished to receive training in advance of ACP implementation .The majority of staff agreed that surrogate decision-making in the absence of family members should be discussed by a multidisciplinary medical and care team, and that the results should be approved by an ethics committee. Conclusion: Training for staff is necessary for the promotion of ACP in medical-type residential care facilities for children with disabilities.

Dialysis patients’ views on withdrawal from dialysis and palliative care are unclear. We conducted a survey of hemodialysis outpatients in Tochigi prefecture regarding withdrawal from dialysis and palliative care. Among a total of 2170 questionnaires sent, 481 (22.2%) valid responses were obtained. The results showed that 160 (33.3%) answered yes to the question whether they would like to withdraw from dialysis if it becomes too difficult to continue dialysis treatment. Of these, 118 (73.8%) answered they would make that decision by themselves, 107 (22.2%) were currently in some kinds of suffering. In terms of awareness of palliative care, only 60 (12.5%) responded that they knew about palliative care, which was clearly less than in the survey on awareness of palliative care for cancer among the general Japanese population. These results suggested the necessity to promote awareness of palliative care among dialysis patients.

Introduction: We report two cases of surgery under general anesthesia during cancer pain management of patients with methadone therapy. Case 1: A 57-year-old woman was started on methadone for pain from right breast cancer with multiple bone metastases, and right mastectomy was performed during the course of chemotherapy. There was no exacerbation of cancer pain due to methadone withdrawal, although analgesics were used temporarily for wound pain. Case 2: A 76-year-old man was placed on methadone for pain from lung cancer. There was concern that lower limb paralysis would develop from a compression fracture of the lumbar spine that had occurred during the course of treatment. Therefore, decompression and fixation surgery was performed. Ketamine was used to control intraoperative pain exacerbation, and fentanyl was used by continuous injection for re-exacerbation of pain after the patient had awakened from anesthesia. Conclusion: Since methadone is available only by mouth in Japan and the equianalgesic ratio between methadone and other opioids has not been established, caution is needed for perioperative pain control while oral methadone cannot be administered. Thus, pain and palliative care specialists prescribing methadone are expected to play an active role in adequate perioperative pain control.

A 67-year-old man with Stage IV gastric cancer (cT3N2M1) received chemotherapy. However, he had progressive disease and then, received palliative care. One day, he was admitted for difficulty in body movement. He had severe anemia (Hb: 3.4 g/dl) caused by tumor bleeding and needed frequent blood transfusions. Palliative radiotherapy (RT) was conducted to control the bleeding. However, hemostasis was not achieved despite daily palliative RT and blood transfusions. Gastrointestinal endoscopy showed oozing blood from gastric cancer and his Hb levels dropped to 2.8 g/dl. Transcatheter arterial embolization (TAE) with gelatin sponge was performed as salvage therapy. TAE was effective and his Hb levels improved to 8.0 g/dl, and he was discharged from the hospital. RT is an effective modality for gastric bleeding control in gastric cancer. However, salvage therapy is sometimes needed but difficult to conduct. TAE was effective salvage therapy in this case.

The need for palliative care for heart failure patients has been attracting attention, but the system for providing such care is not yet fully established in Japan. Iizuka Hospital is a 1048-bed acute care hospital located in Fukuoka, Japan. The Heart Support Team (HST) was established to provide palliative care for heart failure at the hospital. After the HST was launched in May 2017, 168 referrals for palliative care intervention for heart failure patients by March 2022. Twenty-five (14.8%) met the intervention cases’ additional palliative care treatment criteria. The Integrated Palliative Outcome Scale was administered to 11 consecutive patients from April 1 to 30, 2021. In establishing and operating the HST, the challenge was recruiting, training, and creating a system to sustain the system. Creating the HST in collaboration with staff specializing in palliative care, psychiatric care, and cardiovascular specialists was the first step in establishing a method for palliative care to heart failure patients in an acute care hospital.