As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.

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The primary aims of this study were; 1) to investigate the appropriateness of the analgesic therapy in hospitalized cancer patients, and 2) to explore the effects of the screening system by a pharmacist-palliative care physician screening team on analgesic regimens.
The pharmacist-palliative care physician screening team screened consecutive cancer patients about the adequacy of analgesic treatments and provided written recommendations to primary physicians. Inclusion criteria were cancer patients admitted to oncology wards, not having been consulted to palliative care team, and receiving opioid or chemotherapy. Of 62 patients screened, analgesia was inadequate in 44%, and preemptive pharmacological treatments for opioid-induced nausea and constipation was lacking in 42% of 43 patients who had received opioids. The team provided a total of 80 recommendations for 52 patients, and primary physicians followed 94% of the recommendations within one week. The pharmacist-palliative care physician screening team may contribute to better analgesia in patients not having been consulted to the specialized palliative care service.

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Purpose: Doctors were reluctant to disclose a cancer diagnosis to patients in the 1980' s. Clinical pharmacists strive to reduce adverse events caused by chemotherapy and manage pain control and symptoms. We tracked changes in the quality and quantity of information on cancer patients provided by medical staff over 17 years in Kanazawa University Hospital. Methods: We questioned doctors and nurses about the same items in 1988, 1996 and 2005 and compared their replies. Results: Most doctors working on a gastroenterology ward did not reveal cancer diagnoses to patients in 1988 even for early stage cancer, but 70% of doctors did reveal early stage cancer diagnoses in 1996. In contrast, almost full disclosure was achieved irrespective of the stage of cancer progression in 2005. However, medical staff are now confronted with new issues including how long chemotherapy should be continued and planning strategy for the relief of pain and symptoms associated with cancer progression. Conclusion: Our 17-year investigation indicates that doctors provide a more detailed diagnosis in response to increased medical knowledge among patients, and pharmacists need to actively offer up their own opinions about continuation of chemotherapy or palliative care for managing pain and symptoms.

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Sleep disturbance often leads to physical and psychological distress and contributes to poor quality of life in terminal cancer patients. Midazolam is administered by continuous intravenous infusion in many Japanese palliative care units for the purpose of nocturnal sedation when patients cannot take oral medications or do not sufficiently respond to oral or per-rectal medication. However, there is insufficient data to assess optimal doses and other parameters for administration. In addition, the possibility of tolerance to midazolam reported in several studies is a further limitation. The present study retrospectively surveyed inpatient hospice experience in 19 patients who were prescribed midazolam in an attempt to induce nocturnal sedation. The midazolam infusion rate used for the longest period each day to maintain appropriate sleep without oversadation and with clear arousal on the following morning was defined as the "maintenance dose". Midazolam maintenance doses of 2 patients were greatly increased during their treatment period. Statistical analysis was then conducted in the other 17 patients using NONMEM software to analyze time-dependent changes in maintenance doses and possible associated factors. However, in the other 17 patients no significant time-dependent changes were observed during midazolam treatment. It would suggest that torerance may not be induced by intermittent administration of midazolam. Midazolam maintenance doses were significantly greater in patients treated with haloperidol.

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The external preparation Metronidazole (MTZ) is reported to be useful in controlling the malodor associated with advanced and recurrent breast cancer patients. We prepared two different MTZ external preparations, a 1% MTZ Hydrophilic Ointment and a 0.8% MTZ Carbopol Gel. These preparations were then used to control malodor associated with breast cancer and the results were clinically evaluated. Malodor disappeared within 1 week of administration of either preparation and no adverse reactions were observed. These MTZ external preparations were thus found to be useful in the elimination of malodor as part of the treatment of those patients with advanced and recurrent breast cancer.

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Objective: The Pain Level Memory Device (PLMD) is an instrument which patients can use to record their subjective level of pain. The usefulness of the PLMD on both medical staffs in managing cancer pain and the independence of patients were examined in this study. Method: Ten participants, inpatients at Nagoya University Hospital prescribed opioid drugs for cancer pain, were selected and asked to input any change in their pain level into the PLMD for a 14 day period between February and April 2005. A graph of the resulting data was printed and given to both the patient and medical staffs. And a questionnaire evaluating their experience with the PLMD was developed and administered to both. Relationships between the frequency of use of the PLMD and item-scores on the questionnaire were investigated. Results: The median number of inputs into the PLMD was 4.5 (range: 0.5-11) per day. High usage of the PLMD and each high score for the questionnaire items "The PLMD helped assessment of pain (p<.05)" and "The patients satisfaction with pain control improved (p<.05)" were strongly correlated. Spearman's rank correlation coefficient showed a relationship between the median number of inputs and the questionnaire items, "I used the PLMD whenever I intended to (r=.80, p<.01)", ""I saw graphs (r=.78, p<.01)", "I discussed graphs with my doctor (r=.70, p<.05)", "I felt that I participated in my pain management (r=.82, p<.01)", and "I would recommend the PLMD to other patients (r=.80, p<.01)". Conclusion: These results suggested that the PLMD could assist medical staff in the control of cancer pain and support the independence of patients.

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Objective: Opioid analgesics are normally administered as monotherapy. However, we experienced a patient in whom alleviations of cancer pain, coughing and dyspnea were successfully achieved with the combination therapy of morphine and a fentanyl patch (FP), and the case is reported herein. Case Report: A woman in her fifties, suffering from sigmoid colon cancer, liver and lung metastases, and associated pain complicated with coughing and dyspnea, manifested symptomatic alleviations following the facilitation of treatment with morphine sulphate. Taking into consideration that oral intake would become difficult at some time in the future, treatment switchover to FP was planned. However, in view of the efficacy of fentanyl against coughing and dyspnea having not yet been firmly established, a low dose of morphine sulphate for coughing and dyspnea continued and cancer pain was controlled with FP. Thus, through continued combined use of the two ingredients, morphine and fentanyl, until treatment end, symptomatic alleviations of pain, coughing and dyspnea were able to be achieved. Conclusion: For patients experiencing difficulty with oral intake and suffering from coughing and dyspnea in addition to cancer pain, combined use of a low dose of morphine and FP is considered useful in achieving a stable alleviation of such symptoms.

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