Background: Although several dexamethasone phosphate preparations are commercially available and frequently administered with octreotide acetate, their compatibility remains unknown. Aim: We investigated the effect of pH and sodium bisulphate on the stability of octreotide acetate. Measurement design: Octreotide acetate percentage was measured 3 and 10 days after it was mixed with 2 dexamethasone phosphate preparations containing different concentrations of sodium bisulphate as an additive, and in one that did not contain sodium bisulphate. Solutions were also analysed after they were prepared using phosphate buffer to achieve pH values of 4.0, 7.0, and 9.0. The initial octreotide acetate concentration was 41.7 g/mL. High-performance liquid chromatography was used for measurement. Results: The octreotide acetate percentage in the mixture with dexamethasone phosphate without sodium bisulphate was maintained at 95% for up to 10 days. However, mixing octreotide acetate with the other 2 agents resulted in a significant decrease to 85%. The octreotide acetate percentage was ＜90% after sodium bisulphate-containing solution was stored at room temperature under light-protected conditions for 3 days. The percentage of octreotide acetate in the pH 7.0 solution was ＜90% three days after preparation; however, in the pH 4.0 solution, it was maintained at 95% for up to 10 days. Conclusions: Our results suggest that octreotide acetate is hydrolysed in the presence of sodium bisulphate, leading to a decrease in the percentage of octreotide acetate in the solution, which can be avoided using sodium bisulphate-free dexamethasone phosphate preparations.

View full abstract

Background: The demand for palliative care in Japan has risen over recent years, and training of palliative care physicians is an important problem. However, little is known about unmet needs for education and training systems as well as career development among young physicians who wish to specialize in palliative care. Purpose: To explore unmet needs among palliative care physicians in training. Method: We held group discussions in a forum for physicians of postgraduate year≤15, and analyzed their opinion on topics such as "what are unmet needs?" using theme analysis. Results: Forty physicians participated. Theme analysis revealed the following unmet needs among young physicians; "securing of manpower", "securing of quality of training programs/education", "improvement of network", "removal of many barriers to keeping on a palliative care physician", and "establishment of career models for a specialist". Conclusions:We should discuss solutions for the unmet needs to secure more palliative care physicians.

View full abstract

Introduction: Few studies have examined neuropathological changes such as the degenerative necrosis and demyelination of spinal nerve cells accompanying intrathecal administration of opioids (ITO) to relieve refractory cancer pain. Previous studies have produced conflicting results as to whether or not ITO causes nerve tissue damage. The current study neuropathologically investigated autopsy specimens from patients who received ITO. Methods: Subjects were 7 patients who received continuous intrathecal analgesia and who were later autopsied (4 males, 3 females). Six patients were administered morphine and bupivacaine while 1 patient was administered fentanyl and bupivacaine. The duration of administration ranged from 6-345 days. Results: Two patients who received long-term administration of morphine were found to have severe necrotic degeneration and gliosis of spinal neurons and demyelination in the dorsal horn and dorsal roots. However, neuropathological changes were not noted in Patient 4, who was briefly administered morphine, or in the patient who was administered fentanyl. Conclusion: The total dose of morphine used for ITO and the duration of its administration were suggested to be related to the extent of nerve tissue damage. Thus, nerve tissue damage due to ITO might be primarily associated with morphine.

View full abstract

Introduction: The importance of estimating the prognosis of advanced cancer patients is well known, but clinicians do not estimate survival time accurately. Since there is a need for an objective index to estimate survival time, the utility of the Prognostic Nutritional Index (PNI), which depends only on objective factors, was evaluated. Methods: The PNI was calculated using the following formula, PNI=10×serum albumin value (g/dL)+0.005×lymphocyte count in peripheral blood, at 3 months, 2 months, 1 month, 3 weeks, 2 weeks, 1 week, and within 3 days before death in 278 cancer patients (166 men, 112 women; age range, 33-99 years; mean age, 69.8 years) who died in a hospital surgical unit. Results: Sites of primary diseases included lung, breast, esophagus, stomach, colorectum, liver, biliary tract, and pancreas. The PNI values showed a gradual decrease over time. Changes in the PNI values were lower in non-gastrointestinal cancer patients than in gastrointestinal cancer patients. The mean PNI value was significantly higher in patients who lived >3 weeks (38.8) than in those who died within 3 weeks (32.4). When the PNI cut-off point was set at 35, and it was assumed that the life expectancy was within 3 weeks in cases with PNI <35, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 74.8%, 62.2%, 68.1%, and 69.6%, respectively. Discussion: The PNI appears to be a useful and simple parameter to predict clinical outcomes of patients with terminal stage cancer. Particularly, the PNI is considered feasible for gastrointestinal cancer patients.

View full abstract

Objectives: The aim of this study is to explore prevalence and determinants of complicated grief, depressive symptoms, and suicide ideation among the relatives whose family members died in palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), Inventory of Traumatic Grief (ITG), the item concerning suicide ideation, Care Evaluation Scale (CES), and Good Death Inventory (GDI). Results: Of the 653 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 67%). The results showed 10 (2.3%) respondents with complicated grief and 153 (43.8%) with depressive symptoms. Suicide ideation was appeared among 52 (11.9%) respondents. Multiple regression analysis revealed that ITG was signicicantly associated with both CES and GDI. Patiens' age at death and pre-bereavement health contributed to the suicide ideation of the bereaved family members. Conclusion: The prevalence of complicated grief and depressive symptoms among the relatives whose family members died in palliative care units were 2.3% and 43.8%, respectively. The rates of suicide ideation was 11.9% of respondents. The results suggested that the evaluations about structure and process of palliative care, and quality of death contribute to better adjustment of the bereaved.

View full abstract

Purpose: To investigate the characteristics of sudden abdominal condition change that occur in a palliative care unit, we evaluated the association between these conditions and family acceptance at time of death. Methods: We retrospectively investigated the medical records of 30 terminally ill cancer patients who died of sudden abdominal condition change in our unit between January 2010 and March 2013. We focused particularly on the course of sudden change, symptom relief, explanation of the condition, and family acceptance at time of death. Results: The average time from onset of sudden change in abdominal condition until death was 20.6 hours and the median was 13 hours. Of the 30 total cases, 23 occurred in less than 24 hours. Frequent symptoms during the sudden change were abdominal pain in 28 patients, decreased blood pressure in 21, lowering of consciousness in 12 and disturbed behavior/excitement in 10. Impending symptoms were observed in 18 patients. For patients with good acceptance by family at time of death (21 patients), symptom relief was significantly better, frequency of disturbed behavior/excitement was significantly less, and prior specific explanation was significantly frequent, compared to the poor acceptance group (9 patients). The good acceptance group tended to be have a longer hospital stay, as well as longer time between sudden change and death. Conclusions: Death by sudden abdominal condition change came within 24 hours in a majority of cases. We consider that prior detailed explanation and improving symptom relief helps improve family acceptance.

View full abstract

Objectives: The purpose of this study is to clarify evaluations and needs of bereavement services among the bereaved whose family member died at palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the items concerning bereavement services provided by palliative care units and other resources, and the Center for Epidemiologic Study Depression Scale (CES-D). Results: Of the 661 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 68%). The results revealed that 49% of respondents received "memorial cards". Bereavement services were evaluated positively by 88-94% of respondents. The bereaved relatives with higher level of depressive symptoms signicicantly asked for bereavement services. Conclusion: These findings did not suggest the efficacies of some beravement services provided by a specified unit, but that of each service itself at palliative care units. And this result supported the notion that all the bereaved did not equally want any beravement services.

View full abstract

Objective: The reliability and validity of a scale to evaluate the supportive functions of community-based self-help groups (SHGs) for cancer survivors, which was named the Evaluation of Supportive Functions Scale (ESFS) was investigated. Moreover, factors related to the evaluation of supportive functions were identified. Methods: An anonymous, self-administered survey comprised of items related to the background, evaluation of supportive functions of SHGs, and participation status (frequency of participation, satisfaction with participation, and types of activities undertaken) was conducted with members of SHGs for cancer survivors (n=1,350). Valid responses (573 valid responses, 42.4%) were analyzed and ESFS was developed based on the responses. Results: The 21-item ESFS had excellent internal consistency. Factor analyses revealed a 4-factor solution of internally consistent subscales: Learning, Helping each other, Social involvement and Catalyst for personal growth. There was a significant relationship between participants' evaluation of supportive functions of SHGs with gender, role in the SHGs and type of cancer. The subscales were significantly related to the frequency of participation, satisfaction, and the type and range of activities that were undertaken. Conclusions: ESFS can measure participants' recognition of the utility of SHGs. We have discussed the practical applications of the scale as a tool for measuring the effectiveness of SHGs.

View full abstract

Purpose: This study was to identify the concerns of cancer patients receiving outpatient chemotherapy and perceived positive aspects of their treatment. Methods: We conducted self-administered questionnaire based on Cancer-chemotherapy Concerns Rating Scale (CCRS) among 62 cancer patients receiving outpatient chemotherapy, and who have agreed to participate in the study. Results: The CCRS score was significantly higher among those unemployed or on leave of absence, compared to those with job, and. also significantly higher among those with such adverse effects as fatigue, anorexia and hair loss. More than 90% of the participants answered that they have become more concerned about their health than they were prior to developing their disease, and have felt preciousness of their friends and families. Conclusion: Our results suggested to the necessity in attending to the adverse effects of the treatment, and utilizing social resources in order to address the various concerns of the cancer patients.

View full abstract

Purpose: This study was to develop a scale to measure difficulties encountered by cancer care by nurses and to evaluate the reliability and the validity of the scale. Methods: Self-reported questionnaires were administered to nurses who are engaged in cancer care in Tohoku University Hospital. Results: Of 512 questionnaires distributed to nurses, 356 were completed and returned 70%. We selected 49 items in 6 domains, including "communication" "knowledge and skill" "collaboration with doctor" "disclosure and explanation of disease" "hospital system and regional alliances" and "death and dying" using explanatory factor analysis. Cronbach's α coefficient was 0.68 across domains and ranged from 0.69 to 0.74 for each domain. Construct validity was demonstrated and the scaling success rates were 100% for all domains on multitrait scaling analysis. In terms of the known groups validity, the score for the nurses in the palliative care unit was significantly lower than for nurses on the general wards. Conclusion: This study showed that the scale has sufficient reliability and validity. This scale may contribute to cancer nursing by assessing hospital nurses' perception of cancer care and as a method of determining outcomes of educational or organizational interventions.

View full abstract

Purpose and Methods: Based on the medical records of 56 cases of death from hematologic malignancy, we investigated who decided end-of-life care in the terminal phase and at the end of life, what factor discourages patients from making self-decisions and whether an advance directive about end-of-life care is present. We then extracted the story of the family in decision-making for end-of-life care. Results: In 45 cases, the patient decided end-of-life care at the terminal phase. In 11 cases, the family made the decision on behalf of the patient. In the terminal phase, the factor that most discouraged patients from making a self-decision was dementia, but at the end of life the factor was symptomatic worsening in all cases. In 49 cases, the family decided end-of-life care at the end of life on behalf of the patient. Regarding end-of-life care policy, 49 cases hoped for "do not attempt resuscitation (DNAR)" and 7 cases hoped for life-support treatment. Advance directives were confirmed in 7 cases. Mental conflict about end-of-life care policy was perceived from the family's story. Despite small number of cases, it was suggested that an advance directive reduced psychological burden on the family. Conclusion: It is difficult for the patient to make self-decisions about end-of-care life at the end of life as compared to end-of-care life in the terminal phase. Further studies are required to assess the efficacy of an advance directive.

View full abstract

The purpose of this study is to examine the psychological process and facilitating factors in the participants of a bereavement support group in palliative care settings. The subjects were 12 group members. The data was analyzed by the Modified Grounded Theory Approach. 7 categories, 20 sub-categories and 145 concepts were produced and the following psychological process was identified for the group members: “the difficulties in living after the bereavement,” “expressing their feelings toward the deceased,rdquo; “information exchange about their real life,rdquo; “reorganization of the narrative after the bereavement,rdquo; “objectifying their grief through their experience,rdquo; “positive changes after the bereavementrdquo;. This study indicated that “empowerment through group interaction” improved the psychological process of group members.

View full abstract

Background: The aim of this study was to clarify the decadal trends in the structure and usage status of palliative care units in Japan and the association with length of stay. Methods: We conducted a secondary analysis of data from nationwide surveys of palliative care units conducted by Hospice Palliative Care Japan from 2002 to 2012. Length of stay was divided into three categories (within 30 days, 31 to 60 days, and 61 days or more). Results: Significant decadal trends in usage status were observed: the mean annual number of admitted patients (119±55 persons in 2001, 163.0±77.7 in 2011, p＜0.001), and deaths (99±44, 136±58, p＜0.001) increased and the mean length of stay in a palliative care unit (8±15 days, 39±15, p＜0.001) decreased. Palliative care units with a shorter mean length of stay had significantly more admitted patients, and more discharged patients, and a significantly lower mean ratio of death to discharge, and a lower bed availability rate. In contrast, length of stay was not significantly associated with the structure of palliative care units, including the type of units, number of inpatient beds, percentage of private rooms, and number of staff. Conclusion: The features of decadal trends in the structure and usage status of palliative care units in Japan were a shortening of length of stay, and an increase in the number of patients. Palliative care units with a shorter mean length of stay cared for a larger number of terminally ill patients.

View full abstract

Purpose and Methods: Infection and neoplastic fever is one of the common complication in patients with advanced cancer. To develop a novel method to differentiate neoplastic fever from infection, we performed a retrospective study of hospitalized terminally ill cancer patients at Seirei Hospice from April 2009 to August 2011. Results: We identified a consecutive sample of 12 patients with neoplastic fever and 12 patients with infection as a control. We extracted demographic data, laboratory data, vital signs and symptoms from medical charts. We found significant differences in difference in C-reacive protein value between afebrile and febrile period (p＜0.001), difference of white blood cell count between afebrile and febrile period (p=0.0017), percentages in neutrophil counts (p=0.023), percentages in lymphocyte counts at base line (p=0.011) and the presence of delirium (p=0.012). Conclusion: These findings suggest that we might differentiate neoplastic fever from infection with common laboratory data and their longitudinal change.

View full abstract

Aim: To describe the current use of percutaneous endoscopic gastrostomy (PEG) in long-term care national health insurance facilities (special nursing homes for the elderly, health service facilities for the elderly, and long-term health care facilities), and assess whether its prevalence increased or not between 2007 and 2010. Methods: Based on data from the "Survey of Institutions and Establishments for Long-term Care" by the Ministry of Health, Labour and Welfare, we calculated the prevalence of residents with PEG in each type of long-term care facility in 2007 and 2010. Results: The prevalence of residents with PEG in 2007 versus 2010 was 5.8% versus 8.1% in special nursing homes for the elderly, 3.9% versus 5.9% in health service facilities for the elderly, and 18.4% versus 26.1% in long-term health care facilities. Among residents requiring level 3 or higher care, the prevalence of PEG increased in all three types of long-term care facility. Conclusion: From 2007 to 2010, the use of PEG increased among residents of long-term care facilities requiring level 3 or higher care.

View full abstract

Purpose: This study was to examine both the reliability and validity of the Japanese version of the Caregiver Quality of Life Index-Cancer (CQOLC), which was developed to measure the quality of life of family caregivers of cancer patients. Methods & Results: Study subjects comprised 400 family caregivers who were registered at an Internet research company. The explanatory factor analysis yielded the following 4 domains: psychological burden (8 items); positive emotions (5 items); and financial burden (3 items); disruption of daily living (5 items). The Cronbach's alpha coefficients of the total score and each domain were 0.85 and 0.75 to 0.88, respectively. The total score and each domain were moderately correlated with mental health, vitality, social functioning, general health, role emotinal scores from the SF-36. The intraclass correlation coefficients of the total score and each domain were 0.78 and 0.67 to 0.74, respectively. Conclusion: These results suggest that the Japanese version of the CQOLC has sufficient reliability and validity.

View full abstract

Purpose & Methods: With the aim of investigating how early palliative care intervention should be provided, we conducted questionnaire-based screening and QOL evaluations of patients undergoing first-line chemotherapy before and at 3 to 4 weeks after the initiation of treatment, using "a questionnaire on the ease of daily living" and the EuroQol (EQ5D), respectively. Results: Of the 66 patients who participated in this investigation, 56 completed the second survey. With respect to "Concerns and Worries", more than half of the respondents complained concernes/worries about "Conditions and/or Treatments" both before and after chemotherapy, but there were changes in content between the first and second surveys. "Physical Symptoms" were experienced by more than 80 percent of patients before treatment. After treatment, 13 patients saw improvement or disappearance of their symptoms and 22 patients experienced new symptoms. "Emotional Distress" decreased after treatment. This decrease was more pronounced among patients who expressed concerns about their conditions and/or treatments in the first survey. EQ5D health utility scores tended to decrease in patients who had presented with adverse reactions, but improved in those free of adverse reactions. Conclution: Changes were observed in patients' palliative care needs before and after the initiation of first-line chemotherapy, which indicates a need for sequential screening over the course of treatment.

View full abstract

Purpose: Pharmacists should play a positive role in palliative care. The pharmacy curriculum should also contain content promoting an appropriate attitude toward death. Hence, this study aims to gather fundamental information that can be used to understand the various death attitudes held by pharmacy students. Methods: We targeted 159 sixth-year students of the School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, in 2011. They studied "Up-to-date-Palliative-Care" (an elective subject). To investigate their overall perception of death, we used the Death Attitude Inventory (DAI), developed by Hirai and others (2000), and investigated their views of death on the basis of seven factors. We also classified students on the basis of type of death they had experienced, that is, the death of a household, relative, friend, or pet. We compared the scores obtained for each factor and conducted a logistic regression analysis. Results and Conclusion: We analyzed the data from 120 students (valid response rate: 75.5%). Students who had experienced the death of friend, had significantly higher scores on "Life Purpose" and "Death Concern" (p<0.05). Students who had experienced the death of household etc., statistical positive correlation with "Death Concern" and statistical negative correlation with "Death Anxiety" were recognized.

View full abstract

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

View full abstract

Purpose: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. Methods: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. Result: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (p<0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. Conclusion: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.

View full abstract

Background: Most of cancer caring salons (a following salon) are held at the daytime, and there is no report that we weighed against a salon at night. Purpose: We weigh the participation number of people, the differences of participation reason by the time of salon and examine the problems of the salon at the daytime. Method: From July, 2012 to December, we held salons for two hours. The salon at the daytime started at 14:00, and the salon at night was at 18:00. We distributed the questionnaire to participants and examined them. Results: 69 people participated. 22 people (32%) participated at the daytime, and 47 people were at night (p=0.004). Questionnaires are collected in 55 people; a response rate is 80%. Participants less than 60 years old were eight (40%) at the daytime, and 21 (60%) at night. The most common reason of choice the participant time was "not in particular (55%)" at the daytime, and "circumstances of the work (34%)" at night. Conclusion: Young working generations tend to be hard to participate in the salon at the daytime, and the salon at night may be useful.

View full abstract

Purpose: We investigated the involvement of the pharmacy, as a health care resource that supports regional palliative care, in the treatment of patients who received continuous sedation during home-based care. Method: Of the home-based patients with end-stage diseases who received guidance for the management of home-based care between January 2011 and December 2012, this study involved 13 patients who were treated with sedation to relieve pain, and died at home. The survey items included the improvement of pain levels after the initiation of sedation, the number of prescriptions for sterile preparations, number of home visits made by physicians and pharmacists, and the change in the purpose of home visits made by pharmacists. Result: The improvement of pain levels was 76.9%. The number of prescriptions for sterile preparations and that of home visits made by physicians and pharmacists (per day) significantly increased after the initiation of sedation. Concerning the change in the purpose of home visits, an "emergency situation" became significantly more prevalent. Conclution: In the care of patients undergoing sedation at home, it is necessary to have physicians who can respond to emergency situations; thus, a similar system must be established for the pharmacy as a health care resource that supports regional care.

View full abstract

Purpose: The purpose of this article is to clarify the meanings of palliative care unit volunteers who are bereaved families of cancer patients (hereafter referred to as "the volunteers"). Methods: Authors analyzed narrative by the seven volunteers using SCAT (Steps for Coding and Theorization). Results: Meanings of their volunteering consists of following four themes which consists of nineteen categories, ‘affectation to the place of the patient's death’, ‘motivations’, ‘role to achieve’, ‘actual activities’, Motivations of the volunteers are overlapped with the results by classical motivation theories plus "satisfaction with palliative care", "optimal last moment including death attending harmonized with the family's thanatological view". Supporting to an aspect of palliative care that is place of life rather than that of medical treatment is core of volunteer activities. Conclusion: It is suggested to necessary for medical professionals to intervene with understanding of the volunteers ambivalent feelings so that they can work safely. Suitable moment to start volunteering for them is further problem to solve.

View full abstract

Purpose and Method: It is known that people have insufficient recognition about hospital-based palliative care units (PCUs). Patients with cancer and their families are probably not well informed about PCUs on its admission. To understand the situation of patients and their families before and after PCU admission, a questionnaire survey was performed and evaluated by PCU nurses. Result: As a result, two points regarding PCU admission have become clear. First, about 55％ of the nurses reported that prior to PCU admission, patients and family members lacked proper information about PCUs; about 62% of the nurses felt that PCUs had not been appropriately explained to the patients; and about 37% of the nurses felt that family members had not received an appropriate explanation of PCUs at the time of PCU admission. Second, before PCU admission, the main concern of patients and their families was proper utilization of PCUs. After admission, their main concerns were the extent of treatment provided in the PCU and the progress of the disease. Conclution: These results suggest that appropriate information on PCUs, including the scope of treatment provided to patients and the requirements for PCU admission, is necessary for general ward staff as well as for the patients and their families prior to PCU admission.

View full abstract

Purpose and Methods: Aiming at the relief of suffering by the palliative care team and prompt information sharing between healthcare professionals with various specialties, We introduced new IT cloud system, carried out questionnaire survey and examined the usefulness to 11 persons of healthcare professionals. Five cases where the palliative care team was concerned during the hospitalize became a home palliative care to the tried half a year. Results: All the members were using the personal computer as an input device. Four persons were using the iPhone. Two persons had the experience inputted on the spot. Nine persons of the input time were 5 or less minutes. All the members were perusing at various places by various device. Urgently and vital mail was useful: 3 in six, 2 in three, 1 in one, 0 in one. Information content were suitable: 3 in nine, 2 in two. Cooperation were completed in the smooth: 3 in nine, 2 in two. Have you utilized EIR for the home palliative care?: 3 in nine, 2 in two. Conclution: To the support of information sharing and palliative care team by IT cloud system transduction, the useful probability was suggested in the home palliative care.

View full abstract

Objectives: This study evaluates the relationship between the various words expressing pain and the efficacy of opioid analgesics, in order to provide information on the appropriate selection of analgesic drugs for cancer pain relief. A new and simplified evaluation list for the assessment of pain, including the common words used to express pain, was developed accordingly. Methods: The words expressing pain were classified into three categories based on the Guidelines for Drug Therapy in Cancer Pain. These words were grouped into clusters according to the efficacy of opioid drugs, as expressed by the patients. On the basis of these results, an evaluation list was developed, and its validity was assessed by clinical pharmacists and cancer patients experiencing pain. Results: On the basis of the classification of the words, their relationship with opioid efficacy was summarized, and the results of the cluster analysis were found to be helpful for the development of a new pain evaluation list. Conclusion: Patients use various words to express their pain. By classifying and clustering these words according to the guidelines and the efficacy of opioid drugs, we proposed a practical pain evaluation list for appropriate selection of analgesic drugs in patients with cancer.

View full abstract

Objective: To assess the characteristics and influencing factors of sleep during a prehospitalization period in liver cancer survivors with frequent recurrences. Methods: A sleep pattern and mental health were analyzed in 12 patients who had recurrences of hepatocellular carcinoma during a pre-hospitalization period. Subjective sleep quality was assessed by PSQI-J, and objective sleep quality was measured with a actigraphic method. Results: The mean age of the subjects was 74.1 years and the mean number of recurrence episodes was 3.7. The mean PSQI total score was 6.7. The subjective assessment showed that 50% of the patients had a poor sleep pattern, required more time to fall asleep, had a shorter duration of sleep, and had poor sleep quality. The objective assessment showed that 50% of the patients slept for less than 360 minutes and that the patients did not have disturbance of sleep induction with a sleep latency of 3 to 29 minutes. The mean time of awakening episodes was 3.3. The hypnotic agent, severe fatigue, and poor mental health were identified as factors of the poor sleep pattern, as assessed by the subjective measures, and the hypnotic agent shortened and influenced the time spent awake after falling asleep. The subjective evaluation of sleep demonstrated inconsistency with the objective evaluation of sleep. Namely the patients with poor sleep pattern had higher sleep efficiency and significant short awakening times. Conclusion: The sleep pattern in liver cancer survivors was influenced by the hypnotic agent, mental health, and fatigue.

View full abstract

Case: A 71-year-old woman with diabetes mellitus was diagnosed as end-stage ovarian cancer. She was suffering from stomachache and anorexia because of massive ascites. Although we performed abdominal paracentesis for symptomatic palliation, ascites accumulated again in a few days. In order to control the refractory ascites, we administered intraperitoneal triamcinolone acetonide (10 mg/kg) after the fourth abdominal paracentesis; consequently, the interval between the consecutive abdominal paracentesis procedures was extended remarkably. However, prolonged hyperglycemia occurred despite the administration of a single dose of triamcinolone acetonide, and insulin therapy was required for eight days. Conclusion: To our knowledge, this is the first report of intraperitoneal administration of triamcinolone acetonide that caused prolonged hyperglycemia. Therefore, this drug should be administered with caution in such patients with diabetes mellitus.

View full abstract

Case: We report the case of a female in her sixties with inoperable gastric cancer in which continuous bleeding from the cancer resulted in severe anemia and the need for frequent repetitive blood transfusions. In order to control the hemorrhage, radiation therapy of 30 Gy/10 fractions to the cancer was conducted. Her tarry stool soon stopped, her hemoglobin level increased and transfusion became unnecessary. One month later, gastric rebleeding derived from the marginal area of the radiation field occurred. Additional radiation therapy of 24 Gy/8 fractions was given and successful hemostasis was obtained. The patient has been well without transfusion for four months. Conclusion: It is difficult to control bleeding from advanced gastric cancer if the tumor cannot be resected. Endoscopic hemostasis is not always applicable. Interventional radiotherapy (IVR) can be indicated for arterial bleeding. However, the indication of this treatment is controversial in cases of continuous venous bleeding, as seen in our case. Successful hemostasis by radiation therapy was obtained without severe complications in our case. Therefore, it is conceivable that radiation therapy to resistant venous bleeding from unresectable advanced gastric cancer upon careful consideration of complications is a useful treatment modality.

View full abstract

Introduction: We experienced a case in which acetazolamide proved to be effective for the symptoms of increased intracranial pressure due to carcinomatous meningitis. Case: The patient was a male in his fifties who was diagnosed lung adenocarcinoma. He was suffered from headache and vomiting due to carcinomatous meningitis after his admission to our palliative care unit, so he was prescribed steroids and a glycerin infusion. But only morning headache remained, and we added acetazolamide 500 mg per day and his morning headache improved. Conclusion: This morning headache is thought to reflect exacerbation of raised intracranial pressure through nocturnal hypoventilation with a rise in PaCO2, so it was thought that acetazolamide decreased PaCO2 and relieved morning headache.

View full abstract

Purpose: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. Case 1: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. Case 2: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. Conclusion: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

View full abstract

Introduction: It is said that molecular target agents are more durable than cytotoxicic ones, although they have their own specific side effects. We experienced a case of non-small cell lung cancer with leptomeningeal metastasis and she had molecular target agents, she had palliation of symptom and prolongation of survival time. Case: Patient is 76 years old Japanese woman without smoking history. In April 2010 speech and gate disturbance was appeared on her, she was examined by CT and MRI, these revealed lung cancer, intrapulmonary metastasis, lymph nodal involvement, leptomeningeal metastasis, brain metastasis, and spinal bone metastasis in vertebras (T1bN1M1b, Stage IV). Symptoms such as gate disturbance, decrease of oral intake, drowsiness was regression rapidly, so patient and family decided discharge to go to home. She started to take elrotinib 100 mg on yth May. at home. She took elrotinib 150 mg since 6th June 2010 until July 2011 on her death. 2 weeks after administration of elrotinib she came to be able to eat and get up. On 6th August 2010 after administration of elrotinib primary lesion of lung cancer showed PR by CT, leptomeningeal and brain metastases showed SD by MRI. Grade 2 of skin rashu was manageable with topical corticosteroids. The remaining days from a diagnosis of the metastasis to lung cancer with leptomeningeal metastasis are reported with around three months. A symptom was relieved by the dosage of erlotinib,and there was not a serious side effect, and the patient could survive for one year and 5 months.

View full abstract

This report documents the case of a male in his sixties who developed multiple lymph node metastases after receiving external beam radiation therapy and androgen deprivation therapy for locally advanced prostate cancer. Agglomerated pelvic lymph node metastases caused lower extremity lymphedema, however the patient was administered systemic chemotherapy with docetaxel. Because surrounding normal tissue was already irradiated by the prior therapy, radiation against pelvic lymph nodes by LINAC was in danger of exceeding tolerance dose. Therefore, the patient received stereotactic radiosurgery by cyberknife that has a high degree of accuracy in target identification and localization for pelvic lymph node metastases. The lower extremity lymphedema was declined and his activity of daily living was recovered without obvious side effects. Here we report the case of successfully controlled lymphedema by palliative cyberknife therapy.

View full abstract

Case: Cancer patients without impaired glucose tolerance developed hypoglycemia during the administration of quetiapine. After increasing the amount of the drug, hypoglycemia was developed in the wake of fasting. Discussion: There is a possibility that quetiapine inhibited the hypoglycemic compensatory reactions during starvation. Conclusion: In cancer patients taking quetiapine, it is necessary to observe the onset of symptoms of hypoglycemia as well as hyperglycemia in mind. And blood glucose measurement on a regular basis is desirable.

View full abstract

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.

View full abstract

Purpose: The review of the published reports was performed with the aim of systematic collection and integration of information related to "signs and symptoms" along with their changes among patients after upper gastroesophageal surgeries. Methods: The PubMed and the Japanese healthcare literature database were searched by the following keywords: "gastric cancer" "esopha∗ cancer" "surgery" and "symptom" As a result, 37 articles related to gastric or esophagus cancer were identified. The data were extracted according to each sign and symptom, and were evaluated and discussed. Results and Conclution: Standardized instruments for gastrointestinal symptoms included evaluations about dysphagia, difficulty in swallowing, reflux etc. The incidence of signs and symptoms, or postsurgical recovery processes are different among individual patients. Healthcare professionals should support patients continuously and systematically so that patients can take appropriate health maintenance behavior according to their signs and symptoms.

View full abstract

Introduction: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. State: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. Problem: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

View full abstract