Introduction: Naloxone administration is considered for severe overdose symptoms during opioid administration. However, the actual status of naloxone administration during cancer pain treatment is unclear. Objective: To explore the frequency of patients who received naloxone for opioid overdose symptoms and the factors associated with naloxone administration. Methods: A retrospective study, naloxone use was selected from cancer patients receiving opioids at our hospital from 2014–2022, excluding those undergoing surgery or after tests and procedures. The type of opioid used, route of administration, dose and naloxone administration method, dose, and post-administration response were examined. Results: 18 patients (0.10%) were extracted, opioids at the time of naloxone administration were 81.6 (21–750) mg/day of oral morphine equivalent, and patient status (with duplicates) were: 8 patients with impaired renal function, 7 patients with clinical prognostic weeks, 4/3 patients after opioid change/increase. Discussion: Patients treated with naloxone are more likely to have impaired renal function, terminal stage, and after opioid change/increase, which may be risk factors that require attention for the emergence of overdose symptoms.

Objective: This study aimed to elucidate the sense of self-usefulness among patients with advanced cancer receiving chemotherapy in ambulatory care. Methods: Semi-structured interviews were conducted with 20 patients regarding their desire to contribute to others, their everyday lives, and changes in their roles. The text was subjected to qualitative content analysis. Result: Five themes as the sense of self-usefulness finally emerged: “contribution to others,” “approval from oneself and others,” “value given to existence,” “maintenance of independence,” and “integration of life.” Conclusion: The findings suggest that the sense of self-usefulness among patients with advanced cancer who are undergoing chemotherapy is complex. It involves concerns about their independence being threatened and their awareness of the limited time remaining, alongside the looming specter of death amid the worsening and progression of their disease.

Nine cancer survivors who had experienced the suspension of cancer salon activities due to the Coronavirus Pandemic were interviewed about their desires for a cancer salon, and five categories were extracted. The following were identified: [I want a place where I can feel safe to be myself and exchange information] [Desire to have a medical professional with expertise stationed] [I want to meet other cancer survivors in person and feel their experiences close to me] [It is difficult to empathize and communicate with each other remotely, and it leaves me with a sense of inadequacy] [I want a place where I can make use of my cancer experience]. Even in a social situation where face-to-face interaction is difficult, we found that there is a desire to continue interaction with cancer survivors at cancer salons, not only for information gathering and chatting, but also because they feel it is worthwhile to live. It was suggested that it is important for cancer salon organizers to devise ways to continue cancer salons without suspending them, such as infection control measures and holding them remotely, so that participants can freely interact and empathize with each other.

Objectives: This study aimed to describe the difficulties faced by physicians in providing palliative care to patients with cancer in facilities without palliative care specialists. Methods: Semi-structured interviews were conducted with 11 physicians involved in cancer treatment who were affiliated with facilities having no palliative care specialists such as Diplomate or Board Certification of the Specialty Board of Palliative Medicine of the Japanese Society for Palliative Medicine. The interview data were analyzed using qualitative content analysis. Results: The participants had “difficulties in palliative care consultation” because they could not consult with specialists or medical staff at their own facility, when immediate response to cancer symptoms was required. This was partly due to “difficulties in regional cooperation”. In addition, the participants had “difficulties in alleviation of symptoms” for highly complex symptoms of patients with cancer. Behind these difficulties, there was “difficulties in foundation of providing palliative care for individual physicians” including limited time available to the participants. Conclusion: These findings show that there is a necessity to establish a continuous external consultation system for specialists to respond to the immediacy of changes in symptoms and highly complex symptoms.

Objective: To clarify how older breast cancer survivors after cancer treatment perceive cancer patient associations as support for long-term survival. Methods: Six older breast cancer survivors after cancer treatment were asked about the support that they received from the patient association and their thoughts about it using semi-structured interviews. Results: Older breast cancer survivors who have undergone cancer treatment have been aware of the following aspects of patient associations: “Patient associations can share worries after cancer treatment and help them live with cancer”, “The patients reflect on the recurrence, metastasis and death of fellow survivors they have encountered during attending patient associations” and “They felt that their own situation changed as they have participated in patient associations over the long term and that it was difficult to continue”. Discussion: Patient associations are an important resource for older breast cancer survivors after cancer treatment, and our results suggest that it is necessary to consider the form of patient associations that allow continued participation and to establish a system for collaboration with local medical and welfare institutions in order to provide support during the long-term survival phase.

Objective: This study objected to investigate temporal changes in opioid usage one week before death in terminally ill pediatric cancer patients, objecting to identify factors influencing opioid use. Methods: We retrospectively reviewed charts of pediatric cancer patients who died at the National Cancer Center Hospital between January 1, 2014, and October 31, 2022. Opioid morphine equivalent daily doses per body weight (OMEDD/kg)(mg/kg/day) were analyzed for age groups (<14 years vs. ≥14 years) and tumor types (hematologic malignancies vs. solid tumors) one week, three days, and one day before death. Results: A total of 36 patients were included in this study. Patients aged <14 years had higher OMEDD/kg compared to those aged ≥14 years at all three time points. Hematologic malignancy patients had lower OMEDD/kg compared to solid tumor patients one week and three days before death, with a trend towards equivalence on the one day before death. Conclusion: The study suggests that opioid use in terminally ill pediatric cancer patients varies according to age and tumor type, highlighting the need for individualized consideration of patient factors.

This study aims to clarify the impact of continuous outreach activities on home care nurses in a community where palliative care professionals are absent. We have continued this outreach activities in Tome-City, Miyagi Prefecture, Japan since July 2018 and conducted the questionnaire surveys (five-point scale and text open-ended questions) at the beginning of the activities, and two years later, using a Likert method and free writing about their difficulties, confidence and motivation regarding palliative care. As a result, home care nurses in Tome City (39 respondents at the start of palliative outreach, and 24 at 2 years) completed the survey. There was no significant difference between at the start and after 2 years, but 66.7% of participants reported outreach activities as effective after 2 years. In our analysis of free-form text responses, that nurses’ perspectives of end-life care had expanded and their confidence improved over time. There is possibility that outreach activities are useful in reducing their difficulties and improving their confidence. However, it will take time over the medium to long term to spread the influence to the entire region.

There are few reports on opioid pharmacokinetics and opioid switching in patients with small intestinal stomas. We experienced a case in which a 40-year-old man with an ileostomy experienced shortened analgesia and increased pain after switching from a fast-release to an extended-release formulation of tramadol. It is possible that the time required for passage through the small intestine and the absorption capacity of the extended-release formulation were insufficient for the extended-release formulation to function effectively, and that more detailed medication adjustment is necessary for patients with small intestinal stomas.

Introduction: We experienced a case of lung cancer in which arthrocentesis and radiation were effective in treating pain caused by malignant joint fluid. Case: An 80-year-old man was referred to our hospital because of right shoulder pain and difficulty in raising his right hand. Whole body computed tomography (CT) showed right lung tumor, multiple liver metastases and multiple bone metastases. There were also bone metastases in the right scapula and joint fluid accumulation in the right shoulder joint. He was irradiated for bone metastases in the right scapula, but the pain remained, although it had not worsened. Therefore, an arthrocentesis of the right shoulder joint was performed and pain was alleviated. In addition, the diagnosis of non-small cell carcinoma was made by joint fluid cytology. A biopsy was also taken from the right lung tumor, and as the histological diagnosis was similar to that of the joint fluid, chemotherapy was started. CT after the start of treatment showed a decrease in the right shoulder joint fluid and no progression of right scapular metastases. Conclusion: In case of malignant joint fluid associated with bone metastases, a severe prognosis is expected, but arthrocentesis and irradiation can reduce pain.

A 60-year-old woman was treated with oxycodone extended-release tablets for the cancer pain due to cervical cancer, and oxycodone was continued for abdominal pain due to radiation enteritis, laparotomy, small bowel obstruction, and constipation even after the cancer had been cured with chemoradiotherapy. The patient experienced severe drowsiness, and the opioid analgesics dose was gradually reduced. The dose was reduced by switching from oxycodone extended-release tablets to morphine powder. The patient’s drowsiness, constipation, and abdominal pain improved with reduction in opioid dosage, but she developed malaise, sweating, and agitation. These symptoms improved with morphine powder; thus, she was diagnosed with opioid withdrawal syndrome. We attempted to further reduce the dose gradually over a period of four years, but withdrawal symptoms reappeared when morphine powder was discontinued. Therefore, at present, we are administering her small doses of morphine powder. Though inappropriate use of opioid analgesics should be strictly avoided, in some cases, long-term use under careful specialist supervision may be necessary before discontinuation of opioid analgesics.

Background: Patients with malignant brain tumors are often accompanied by progressive loss of consciousness, aphasia, and paralysis, and often miss the time to make decisions on their own. Methods: In an acute neurosurgical unit, a multidisciplinary conference was held to support decision-making, and a brain tumor-specific advance care planning (ACP) leaflet was created and operated. The attainment rate of the five steps of ACP and the number of times the ACP process was repeated during hospitalization were evaluated for 79 inpatients before and after the introduction of the leaflet. Results: Forty-eight patients received decision-making support with the leaflet, while 31 did not. The rate of achievement of the discussion (38.7% vs 89.6%, p<0.001) and writing down (6.5% vs 33.3%, p=0.006) in ACP significantly increased after the introduction of the leaflet. Conclusion: The newly developed brain tumor-specific ACP leaflet was useful in promoting ACP for patients with brain tumors and providing decision support. In addition, a multidisciplinary ACP support framework for brain tumor patients has been established through ACP conferences.