Purpose: The purpose of this study was to develop a scale that can measure the concerns of cancer patients undergoing outpatient radiation therapy. Method: First, items were created based on a review of the literature, and a draft scale was created by examining content validity using the Item-level Content Validity Index (I-CVI). In the main study, researcher conducted an anonymous, self-administered questionnaire survey on 400 cancer patients undergoing outpatient radiation therapy at five institutions, and examined the reliability and validity of the scale. Result: Exploratory factor analysis identified nine items with two factors (concern about living with cancer and concern about living with irradiation). The Cronbach's alpha coefficient for the entire scale was 0.848. The goodness of fit in confirmatory factor analysis showed GFI=0.930, AGFI=0.879, CFI=0.926 and SRMR=0.058. No correlation was observed with STAI Y-1, and a certain level of discriminant validity was confirmed. Conclusion: We generally confirmed the reliability and validity results of a concern scale for cancer patients receiving outpatient radiotherapy.

We investigated the impact of Bazett (B) and Fridericia (F) correction formulas on the evaluation of QT prolongation in patients during methadone administration and to explore the relationship between heart rate and corrected QT interval (QTc) according to both correction formulas. This study was conducted as a single-center, retrospective observational study. Subjects were cancer patients who underwent electrocardiographic evaluation for methadone therapy at our institute from April 1, 2013, to August 31, 2023. The study assessed the incidence of QT prolongation and analyzed the correlation between heart rate and QTc derived from the B and F formulas. The mean QTc of 430.3±25.8 msec for the B formula and 409.2±20.8 msec for the F formula. The incidence of QT prolongation was significantly lower with the F formula (8.4%) compared to the B formula (27.7%), indicating a 19.3% reduction in QT prolongation cases (p<0.001). Additionally, the difference in QTc between the two formulas increased with an increase in heart rate (p<0.001). These results suggest that the F formula for QT interval correction in methadone therapy potentially expands the eligible patients for this therapy.

Purpose: This study aimed to develop a scale to measure nursing practice in end-of-life (EOL) care and examine its reliability and validity. Method: A cross-sectional survey using an anonymous self-administered questionnaire was conducted among nurses working in wards with ten or more patient deaths in the previous year among four hospitals with palliative care units. Results: Of 369 questionnaires distributed to nurses, 79 (21%) were completed and returned. As a result of the exploratory factor analysis, a scale consisting of 18 items in one subscale was developed Cronbach’s alpha coefficient was 0.95 for the entire scale, indicating sufficient internal consistency. Comparison of scale scores between groups that received comprehensive EOL education and those that did not demonstrated known group validity. Conclusion: The newly developed scale to measure nursing practice in EOL care was confirmed to have sufficient internal consistency and known group validity. This scale may contribute to measuring nurses’ EOL care practices regardless of diseases and the effectiveness of EOL nursing education.

Background: The extent and nature of support provided by social workers in palliative care unit (PCU) remain insufficiently elucidated in the current literature. Objective: The objectives of this study are: (1) to clarify the intervention status and support activities of social workers in PCU, and (2) to identify the relevant factors related to bereavement support in PCU. Methods: A self-administered questionnaire survey was conducted targeting social workers responsible for support in PCU. Results: An overall understanding of the intervention status and support activities of social workers in PCU was obtained. Additionally, it was found that factors related to experience, such as social workers’ professional experience and practical experience in PCU, were related to bereavement support. Conclusion: For social workers to provide comprehensive support in PCU, it is important for them to accumulate professional experience as social workers and practical experience in PCU. Furthermore, creating an environment that facilitates this accumulation of experience is also crucial.

Objective:We compared changes in BMI as well as nutritional and fluid intake in older adult patients who died and survived while in special nursing care facilities, and examined whether trajectories in the death group were effective in predicting prognosis. Methods:We retrospectively extracted data from BMI, nutritional and fluid intake for all older adults admitted to a special nursing care facility between April 2007 and the end of July 2022, searching for changes in the monthly mean values. Results:Data were obtained for 646 patients in the death group and 498 in the survival group. In the death group, BMI, nutrition and fluid intake decreased significantly from 12 months before death compared with the survival group. In the death group, nutrient intake per kilogram of body weight decreased significantly and irreversibly as of 6 months before death, and fluid intake decreased significantly and irreversibly starting 3 months before death compared with the previous month. Discussion:The trajectories of BMI, nutrition and fluid intake decreased simultaneously from 12 months before death, and the significant irreversible decrease in fluid intake followed by nutritional intake per kilogram body weight was effective in predicting the prognosis of elderly patients dying in special care facilities.

Objective: To clarify changes in the quality of life (QOL) of ambulatory patients with locally advanced/metastatic cancer who underwent rehabilitation in a palliative care unit. Methods: Patients aged 18 years or older who were admitted to the Palliative Care Unit, had a Functional Ambulation Category of 1 (assisted ambulation) or higher, and were assessed at admission and two weeks after admission using the Comprehensive Quality of Life Outcome (CoQoLo) short version, were included in the study. Results: Twenty-one patients completed the 2-week assessment. Ten subjects were male, with a median age of 78 years. The Functional Independence Measure cognitive items significantly declined 2 weeks after admission, but the CoQoLo total score was not significantly different. In addition, the rate of change in the CoQoLo item “Being respected as an individual” was significantly higher in the ≥4 days/week rehabilitation intervention group than in the <4 days/week group. Conclusion: This study has shown that it is possible to maintain the QOL of ambulatory patients with cancer who received rehabilitation in a palliative care unit.

Objective: To evaluate nutritional status by measuring triceps skinfold thickness and arm muscle circumference in the palliative care ward. Methods: We analyzed 31 terminal cancer patients in the palliative care ward, whose Palliative Prognostic Index (PPI) predicted a prognosis of 21 days or less. Measurements were taken once a week from the time of admission to the ward until the prognosis became daily. Results: Measurements could be performed in all patients. Triceps skinfold thickness, which reflects fat mass, was highly impaired in 80.6% of patients. The arm muscle circumference, which reflects muscle mass, was severely impaired in 3.2%, moderately impaired in 29.0%, mildly impaired in 38.7%, and normal in 29.0% of patients. Multiple measurements were obtained in 16 cases, but only two patients, whose triceps skinfold thickness and arm muscle circumference were normal or mildly impaired from the time of admission until 4 weeks later, had a prognosis of more than 56 days. Conclusion: Routine measurement of triceps skinfold thickness and arm muscle circumference in the palliative care ward may improve the accuracy of prognosis prediction.

Abdominal paracentesis is a standard intervention for symptom relief in patients with ascites; however, there is no established agreement regarding the optimal speed of ascites drainage. This paper presents three cases of rapid manual drainage of ascites (RMDA) conducted during home visits: a 72 year-old male with intractable cirrhosis, a 73 year-old male with malignant ascites secondary to cancer of the pancreatic tail, and a 54 year-old male suffering from malignant ascites due to pancreatic tail cancer with hepatic metastases. Drainage volumes ranged from 1.4 to 3 liters, with procedures taking between 12 to 14 minutes. Post-procedure systolic blood pressures were maintained above 90 mmHg at immediate, 2 (±1) hours, and 24 (±12) hours following the procedure in all cases. No severe adverse events were reported. RMDA may offer a reduced procedural time in the home visit context, lessening patient discomfort and healthcare provider costs. Further studies are needed to evaluate the safety of RMDA in home care settings.

Introduction: Intracranial tumors cause various neurological symptoms and neuropathic pain, which are often refractory to opioids. In some of these cases, the combination of Kampo medicines can be effective. Case: The case was a 44-year-old patient who underwent surgery for a suspected papilloma. After resection, pathological examination revealed squamous cell carcinoma, positive for margins, and then, the left intraorbital metastasis was observed. Due to the intracranial invasion of the tumor, he had pain in the second and third branches of the trigeminal nerve in the left face and paresthesia in the second branch of the trigeminal nerve bilaterally (Numerical Rating Scale: NRS 10/10). Hydromorphone was introduced, and the pain was relieved, but the paresthesia remained (NRS 8/10). Both paresthesia and pain worsened during the course of chemotherapy, but MRI showed no tumor progression, thus, the cause of symptom aggravation was diagnosed edema of the tissue around the tumor. Therefore, Goreisan was started, and both paresthesia and pain were relieved. Discussion: Goreisan has been shown to be effective in cerebral edema due to its water-regulating effect by inhibiting aquaporin. In the present case, the reduction of edema in peritumoral tissues by Goreisan may have contributed to the symptomatic relief.

Hydromorphone is known for its low bioavailability. Currently, there is no recommended conversion ratio when changing from injectable to oral hydromorphone for patients with hepatic impairment. Its overdose may result in serious side effects, particularly respiratory depression, necessitating careful attention to dosage. In the present case, a patient with hepatic impairment developed respiratory depression following a switch from continuous subcutaneous administration of hydromorphone to an oral extended-release form. The prescribed oral dose of hydromorphone was four times higher than the injectable dosage, based on the standard conversion ratio typically considered equivalent in drug potency. However, increased bioavailability due to hepatic impairment is believed to have caused the patient’s respiratory depression. Therefore, in such cases, it is imperative to cautiously monitor dosage due to significant fluctuations in the conversion ratio, which varies based on individual circumstances.

Objective: To introduce a successful experience of tapering high-dose opioids using spinal analgesia. Case: A 53-year-old man suffering from buttock-pain due to sacral metastasis of rectal cancer, was referred to our hospital for specialized cancer pain treatment and opioid reduction. At the time of admission, he was taking 5040 mg/day of oral morphine equivalent dose of opioids and NRS was still 10/10. Although the dosage was too high, an illicit transactions, diversion or psychological dependence were ruled out. Exacerbation of pain and tolerance formation due to the rapid increase of opioid dose seemed to be a vital factor. After admission, the high-dose opioid was gradually reduced while epidural and intrathecal analgesia were introduced. After 30 days of adjustment, the dose of systemic opioid was finally reduced to 120 mg/day (oral morphine equivalent) with 24 mg/day of intrathecal morphine at the time of transfer to his primary hospital. Conclusion: Cancer pain can result in high-dose opioids administration. Specialized pain treatment may be useful in weaning patients from high-dose opioids, but early concomitant use is recommended to avoid becoming high-dose opioid.

The usefulness of acupuncture and moxibustion as complementary and alternative medicine in the field of palliative care, in recent years. Since August 2021, acupuncture and moxibustion therapy was integrated into the palliative care team at Tokai University Hospital, an advanced acute care hospital. We present an overview and activities of the acupuncture and moxibustion therapy team at our hospital. Within approximately 1 year and 3 months, 35 patients (14 men and 21 women) presented for acupuncture and moxibustion therapy, which corresponds to 10% of the number of patients treated by the palliative care team. The most common reason for consultation was requests for physical pain, especially pain (55%), indicating a need for acupuncturists to relieve pain. The most common treatment method was warm moxibustion, suggesting the influence of painful or scary images of acupuncture. The majority of patients also wanted acupuncture intervention until discharge from hospital. The presence of a need for acupuncture for temporary relief of pain as well as temporary improvement of mental state, including relaxation, was suggested.