Purpose: This study investigates the situation surrounding the use of massage to relieve cancer pain by nurses in hospices and palliative care wards all over Japan and factors affecting this usage. Methods: We conducted a survey of 989 nurses with two or more years of clinical experience employed at approved palliative care wards around Japan, using a questionnaire prepared by researchers. Results: The questionnaire was answered by 606 nurses, and 95.7% of the subjects used massage in their routine nursing care. They recognized the benefits, such as comfort, reducing anxiety and so on. From a multivariate logistic model, 'a great number of years of clinical experience in cancer nursing' (OR: 2.51, 95%CI: 1.20-4.80) and 'the superior assessment ability for the use of massage' (OR: 1.18, 95%CI: 1.09-1.27) had a significant impact on the active use of massage. Conclusion: In order to use massage more effectively it is necessary to develop knowledge acquired through clinical experience and improve nurse's assessment ability. Palliat Care Res 2010; 5(1): 101-113

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Purpose: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. Methods: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. Results: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. Conclusion: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126

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Purpose: To investigate the job satisfaction, burnout, and related factors associated with palliative care-certified nurses. Methods: In 2005, we performed a mail-based questionnaire survey on palliative care-certified nurses was performed using job-satisfaction and Burnout Inventory. Related factors such as working place and clinical experience were also asked. A multivariate logistic regression analysis was employed to investigate relationship between burnout and the factors. Results: Of the 171 questionnaires delivered, 137 were returned (81.1%). The means of the job satisfaction subscales were as follows, professional status: 32.6±6.5, interaction: 26.4±6.7, autonomy: 17.5±5.2, doctor-nurse relationship: 8.6±3.6, administration: 28.5±8.5, pay: 24.0±7.8, task requirement: 13.2±5.4, and mean total, 150.6±29.8. Seventy palliative care-certified nurses (51%) showed signs of burnout. On the basis of multivariate logistic regression analysis, 9 factors, including those related to respondents working in cancer hospitals (odds ratio <OR>: 34.67, 95% confidence interval <CI>: 2.90-414.29) were observed to be associated with burnout. Conclusion: In order to facilitate the activities of palliative care-certified nurses, it might be useful to provide them with workplace-specific training and support. Palliat Care Res 2010; 5(1): 127-136

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Purpose: Evaluation of the efficacy and safety of sublingual drug administration in palliative care patients lacking the ability to swallow as well as other drug administration routes. Methods: Buprenorphine, 0.1∼0.2mg/dose (n=15) and fentanyl, 0.05∼0.2mg/dose (n=26) were administered sublingually for cancer pain, and midazolam, 0.1mg/kg (n=16) for insomnia respectively. Results: The three drugs were all rapidly absorbed by the oral cavity and showed efficacy in about 90% of patients. No adverse events were observed other than drowsiness, nausea and over production of sputum in patients suffering from dysphagia. Conclusion: Sublingual administration is a viable alternative for maintaining the quality of life of patients not accessible through conventional administration routes in the palliative setting. Palliat Care Res 2010; 5(1): 201-205

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Purpose: A case of effective pain control by opioid rotation from fentanyl patch (oral morphine:fentanyl=100: 1 ratio) was succeeded with less than the theoretically equivalent conversion dose. Therefore, an investigation was undertaken to determine the effective rotation dose from fentanyl patch to other opioids. Methods: Retrospective analysis was carried out on patients with cancer-related pain, who were switched from fentanyl patch to other opioids. Results: Fourteen patients were analyzed and the average effective dose of opioids after the rotation was 76% of the theoretically calculated dose. Effective doses after opioid rotation were less than calculated doses in 11 cases (79%) and more than calculated doses in only 3 cases (21%). Effective doses after opioid rotation were 101% of calculated doses in cases (n=5) with less than 75μg/hr of fentanyl patch, but 63% in cases (n=9) with more than 75μg/hr. Conclusion: Opioid rotation should be considered when administration of more than 75μg/hr of fentanyl patch is needed. It is necessary to reduce the amount of applied dose to approximately 60% of calculated dose for safe opioid rotation. Moreover, it is necessary to remain careful and to provide immediate assistance in case of emergency due to withdrawal syndrome. Palliat Care Res 2009; 5(1): 301-307

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We report two cases of myoclonus following the administration of gabapentin for neuropathic pain in the end stage of malignancy. Patient 1: A septuagenarian woman with sarcoma of the uterus was admitted to our hospice. She complained of severe neuropathic pain in her left leg caused by an invasive lumbar tumor. To reduce the neuropathic pain, she was administered 200mg of gabapentin daily. Four months later, the gabapentin was increased to 400mg daily due to worsening pain in her left leg. Three days later, she felt muscle weakness in her left arm and frequent muscle twitches were observed even during sleeping. Myoclonus associated with gabapentin administration was suspected. The myoclonus disappeared after cessation of gabapentin for 2 days. Patient 2: An octogenarian man with renal cell carcinoma was admitted to our hospice. He was administered 200mg of gabapentin daily to reduce the neuropathic pain felt in his back and bilateral leg due to a metastatic tumor of a para-aortic lesion. On the next day, frequent muscle twitches were observed in his extremities and upper trunk while he was sleeping. Myoclonus associated with gabapentin administration was suspected, which disappeared within one day following cessation of the drug. Myoclonus is a rare side effect of gabapentin, but it may occur even with the low-doses given to patients with end-stage malignancy. Although the pathogenic mechanism of induction of myoclonus by gabapentin was suspected to be heterogeneous, discontinuation of gabapentin should lead to rapid resolution of symptoms. Palliat Care Res 2010; 5(1): 308-313

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