Purpose: To clarify factors associated with the Japanese perception of whether they can live at home until death with the inclusion of knowledge and beliefs about end-of-life. Methods: A questionnaire survey was conducted on the Japanese general population who participated in a lecture meeting about palliative home care (N=61, effective response rate, 100%). Results: Ten (16%) responded they could live at home until death. Barriers to end-of-life home care were "Home care would burden my family (80%)," " Family and I are anxious about emergency care when I get worse (59%)" and "Family and I are anxious about whether I can enter a hospital emergently when I get worse (52%)" in that order. From the multivariate logistic regression model, respondents who expressed "Opioids cause addiction (OR, 95% confidential interval (CI):0.29, 0.09-0.99)" and "Artificial hydration and nutrition should be continued as the minimum standard until death (OR, 95%CI:0.39, 0.16-0.95)" were more likely to perceive that they could live at home until death. Conclusion: The empowerment activity for the general population regarding correct knowledge about palliative care, benefit and disadvantage of life-sustaining treatment, and correct knowledge about home care is important for the end-of-life patients who want to live at home until death to achieve their wish.

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Like the "day hospices" for cancer patients in England, Japanese day care services may be an effective resource for home-based palliative care. A questionnaire survey was done to investigate what medical services are available to cancer patients in existing day care centers in Japan. Methods: In November 2004, the questionnaire was sent to 108 day care centers in Okayama Prefecture, and there were 49 responses. Results: Out of the 49 day care centers, 36 had been used by cancer patients, 28 (56%) of those centers actually had cancer patients attending at the time of survey, and 4 (8%) of those centers provided special programs for cancer patients. The results of the questionnaire showed that day care centers should provide the following services to enhance domiciliary palliative care for cancer patients: 1) medical palliative treatment; 2) medically supervised special day care services, such as bathing; 3) resting periods to meet the client's needs; 4) medical function support therapy, such as stoma-care, parenteral nutrition, and infusion; and 5) psycho-social support for the patients as well as their families. Conclusion: Existing day care centers in Japan could be effective in functioning as day hospices, similar to those that exist in England.

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We report that a case of maxillary sinus carcinoma with severe pain for radiation oral mucositis was successfully managed by using indomethacin spray. Fifty three-year-old male who was treated with radiation and chemotherapy including 5-FU for his maxillary sinus carcinoma developed oral mucositis with severe pain. Several medications such as diclofenac sodium (tablet), oxycodone hydrochloride (sustained-release tablet), morphine sulfate (fine granule), fentanyl (patch), azulene (gargle) and lidocaine (viscous) did not provide satisfactory effects on the pain control. We, therefore, tried to use indomethacin spray (0.2 mg/0.08 mL/push) with the daily dose of 9.6±5.2 mg (2-10 push/once, 1-11 times daily). Indomethacin spray provided dramatic effects on his pain relief with the significant reduction of pain score (face scale) from 2.4±0.4 to 1.0±0.1 (p<0.01). Mean time for pain relief was 8.7±2.2 min. after applying indomethacin spray. The effects of indomethacin spray on the radiation oral mucositis were evaluated by pain score in five patients with head-and-neck carcinoma. The pain score was improved in all cases after introducing indomethacin spray (before vs. after: 3.2±0.5 vs. 1.6±0.6, p<0.01) with the 8.1±3.8 mg/day. There was no adverse events associated with the use of indomethacin spray. The results suggest that the use of indomethacin spray is an alternative approach to control the pain for radiation oral mucositis in patients under radiation therapy for head-and-neck carcinoma.

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Purpose; Transdermal fentanyl (TF) has less systemic adverse effects as compared to morphine. However, few patients with cancer related pain obtain insufficient analgesic response despite the dose escalation of TF. The aims of this study were to describe patients with poor analgesic response and to evaluate the efficacy of opioid rotation from TF to oral morphine. Case reports; We conducted a retrospective chart review and analyzed six patients managed with opioid rotation in detail. Before opioid rotation, an average dose of TF was 204μg/hr. A significant decrease in pain score was found in all patients who switched to oral morphine, and five patients were treated with the combination of TF and oral morphine. Conclusion; These results may indicate that patients who are treated with relative high dose TF (over 200μg/hr) tended to response to poor analgesic, and opioid rotation is beneficial to restore the analgesic effects. We speculate that this clinical phenomenon is associated with opioid tolerance.

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