Objective: Injectable acetaminophen is frequently used for its analgesic and antipyretic effects. However, its approved route is limited to intravenous administration by prescribing information, which presents a clinical challenge for palliative care patients with difficult intravenous access or who cannot tolerate oral or suppository formulations. This study aimed to investigate the safety and efficacy of subcutaneous administration of injectable acetaminophen. Methods: This study was conducted in the palliative care unit of our hospital. We enrolled patients who required injectable acetaminophen but had difficult intravenous access. A 500 mg dose of acetaminophen was administered subcutaneously. Safety and efficacy were evaluated based on local site reactions, body temperature, pain scores, and subjective symptoms. Results: Thirteen patients received a total of 31 subcutaneous administrations. No clinically significant local adverse events were observed. For pain management, all patients showed a reduction in pain scores and reported symptom relief. For fever, a significant decrease in body temperature was observed at 1, 2, and 4 hours after administration compared to the mean pre-administration temperature. Conclusion: Subcutaneous administration of injectable acetaminophen appears to be a safe and effective option for pain and fever management in palliative care patients, without causing notable local adverse events.

Objective: This case report describes the efficacy and safety of switching opioids from transdermal fentanyl to continuous subcutaneous infusion (CSI) of buprenorphine in a home-based patient with advanced ovarian cancer and renal impairment. Case: A 48-years-old woman with recurrent ovarian cancer and metastases to the liver and peritoneum was receiving home-based palliative care. For peritoneal dissemination-related cancer pain, she had been treated with a transdermal fentanyl patch (37.5 μg/h) and immediate-release oxycodone tablets (5 mg). Due to worsening cancer-related ileus and severe renal impairment, opioids were changed to buprenorphine CSI. Treatment started with buprenorphine at 0.96 mg/day and was titrated to 1.2 mg/day, resulting in sufficient pain relief. With worsening pain, the dose was increased to 1.44 mg/day, leading to enhanced symptom management. No significant side effects were noted following the initiation of buprenorphine CSI. Conclusion: This case may contribute that switching from transdermal fentanyl to buprenorphine CSI is an effective and safe method for managing cancer pain in patients with advanced disease and renal dysfunction.

Mohs paste (MP) has been reported as an effective treatment for alleviating symptoms caused by malignant skin tumors, such as bleeding, malodor, and exudate. However, various challenges have been encountered in its use, such as the complexity of preparation, high costs, and difficulties with application, which are particularly troublesome in home care settings. Consequently, MP has seen limited use in home-based care. We report a case of a bleeding malignant skin tumor, originating from the thyroid, successfully managed in home care setting using sorbitol-containing Mohs paste (SMP). SMP was prepared by substituting glycerin with sorbitol in the standard MP formulation. The patient underwent eleven weekly applications of SMP, which resulted in effective bleeding control and a noticeable reduction in tumor size. SMP demonstrated similar clinical effectiveness to conventional MP while offering improved handling and material properties. These advantages lowered the obstacles to its use, enabling safe and practical administration within the limited resources of home care. SMP’s simplified preparation process also makes it a more accessible option for non-hospital environments. This case suggests that SMP could be a viable and efficient alternative to MP for managing symptoms of malignant skin tumors, particularly in patients receiving palliative care at home. By enhancing usability, SMP may help expand the role of MP in home-based palliative care for advanced malignant skin tumor.

Bereavement of a close relative is recognized as a significant psychological stressor for family members. This study aimed to examine the impact of biological kinship on grief and depression among bereaved individuals who lost a parent. A nationwide questionnaire survey was conducted with family members of patients who died in 2017 and 2018. Grief and depression were assessed using the Prolonged Grief Disorder Scale and the Patient Health Questionnaire, respectively. After adjusting for gender, the prevalence of grief was 17.7% among biological children and 21.6% among daughters-in-law and sons-in-law; the prevalence of depression was 39.1% and 41.7%, respectively. Grief was significantly associated with kinship, whereas no such association was observed for depression. Even after adjusting for related factors such as caregiving frequency, being a biological child remained significantly associated with grief (adjusted odds ratio [aOR]=1.75, 95% confidence interval [CI]: 1.59–1.94). These findings suggest that both groups experienced a high level of psychological distress, regardless of biological ties. Therefore, healthcare providers should offer appropriate psychological support to all bereaved individuals, including daughters-in-law and sons-in-law—without making assumptions based on kinship.