The purpose of this study was to clarify the survey of non－pharmacological interventions provided by nurses in palliative care units for dyspnea in terminally ill cancer patients. A survey of 450 palliative care unit nurses working in the Kanto and Koshinetsu regions was conducted using an anonymous, self－completed questionnaire between September and November 2011. Data on 414 respondents (response rate, 92.0%) were analyzed. The questionnaire was based on a literature review and interviews with nurses, and it asked about the frequency of non－pharmacological interventions (nursing support) in 31 items and the nurses’impressions of whether these interventions were effective. In the items which frequency of intervention was high, there are nursing support which provide with ease and nearly cost or time free. In the low, there are nursing supports which need for knowledge and skills when the supports are provided. In the items which impression that it was effective was high, there are similar supports with frequency of intervention. These results may be useful when discussing future support for dyspnea in patients with terminal cancer.

View full abstract

Purpose: To clarify the effect of a palliative care team intervention for nausea of cancer patients. Methods: The study participants were all cancer patients who were referred to a palliative care team in Yodogawa Christian Hospital in 2010, and had nausea with score 2 or over of the Support Team Assessment Schedule Japanese version (STAS－J). The causes of nausea were classified into 4 categories. Etiology－based antiemetic medications were recommended, and the intensities of nausea were assessed using the STAS－J on the day of referral, and 7 days after. Result: Among 27 patients were recruited for this study, 24 were assessed 7 days after. Nine patients had chemically induced nausea, eight had impaired gastric emptying, four had vestibular and central nervous system disturbance, and three had bowel obstruction. The mean STAS－J score significantly decreased from 3.0 (SD, 0.55) on the day of referral to 1.1 (0.80) after 7 days (p＜0.001). Two patients had mild drowsiness. Conclusion: The recommendations of etiology－based antiemetics by the palliative care team may be effective for managing nausea in cancer patients.

View full abstract

This ecological study revealed the relationship between the percentage of death at home and medical and socioeconomic characteristics. This study was a secondary analysis of national data from the Population Survey Report in 2010 and government statistics in Japan. This data was analyzed by exploratory factor analysis and multiple linear regression analysis. As a result of exploratory factor analysis, medical and social characteristics are classified in three domains, “depopulation and aging”, “hospital and medical facility resources” and “access for home medical care”. By multiple linear regression analysis using results of exploratory factor analysis, cancer death was associated with “access for home medical care” and death from all causes was associated with “hospital and medical facility resources” and “access for home medical care”. In conclusion, death at home in cancer patients was strongly affected by “access for home medical care”. Death at home from all causes was due to poor hospital and medical facility resources and good access to home medical.

View full abstract

Background: Everolimus is a molecularly targeted drug for renal cell carcinoma. It is also approved for pancreatic neuroendocrine tumors ("PNET") and tuberous sclerosis complex ("TSC") in Japan and frequently associated with stomatitis, one of the most common adverse reactions. However, the mechanism of the onset of stomatitis has not been elucidated, and no reports have been published on appropriate prophylaxis against everolimus-induced stomatitis. Method: In the Department of Urology, Yamagata University Hospital, gargling with sodium azulene sulfonate has been used prophylactically since October 2010, when oral treatment with everolimus was first administered at our hospital. In this study, the preventive effect of gargling with sodium azulene sulfonate on stomatitis was evaluated in 21 patients receiving everolimus. Result: The incidence of stomatitis was 53.3% (Grade 3/4: 0%) in the intervention group and 83.3% (Grade 3/4: 16.7%) in the non-intervention group; patients treated in October 2010 or earlier. The grade of severity was significantly lower in the intervention group (Median grade: 1 vs. 2, p<0.05; Mann-Whitney’s U test). However, there was no difference in the time of onset between the two groups. Discussion: Sodium azulene sulfonate effectively prevented stomatitis probably because it not only has anti-inflammatory and mucosal protective effects, but also promotes wound healing. Further detailed analysis will be required in more patients.

View full abstract

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

View full abstract

Purpose: The aim of this study was to clarify the current state and effectiveness of antibiotic use in our palliative care unit (PCU). Methods: Among the cancer patients hospitalized in our PCU between May 1, 2012 and April 30, 2013, the subjects of this study were treated with parenteral antibiotics for infections. All data were retrospectively collected from medical records. Results: Parenteral antibiotics were prescribed in 44.3% of all. The most common sites of infections were the respiratory tract (63.6%) and the urinary tract (18.2%). In 59.1% of the cases, the outcome of use of antibiotics was helpful, in 9.1% of cases there was no change, in 13.6% of cases it was unhelpful, and in 18.2% of cases it could not be assessed. The outcome of antibiotic use was supposed to be excellent for urinary tract infections, but defective for terminal cases near death. Conclusion: The use of antibiotics is common in PCU and the responsiveness of the antibiotics could be different among certain subgroups.

View full abstract

Purpose: We report an advanced pancreatic cancer case with duodenal obstruction successfully treated with percutaneous endoscopic gastrostomy (PEG). Our team, with a common understanding based on ethical considerations, determined how to treat this patient and devised a technically advanced PEG.
Case report: A woman in her 80s with advanced pancreatic cancer received best supportive care. However, she developed duodenal obstruction and could not eat. Therefore, we placed a PEG for decompression based on ethical considerations. We were careful to avoid gastrostomy tube obstruction or peritonitis caused by regurgitation of stomach contents. Her quality of life (QOL) improved when she regained the ability to eat and she returned home.
Conclusion: As to the ethical considerations, a conference the 4 contingency table of team－based clinical ethics was found to be effective. The QOL of this patient improved when ingestible food or PEG for decompression was applied.

View full abstract

This study was performed by the purpose of early detection of Hand－Foot Syndrome (HFS) in patients receiving capecitabine therapy. Ten patients receiving chemotherapy with capecitabine after resection of colon cancer were included in this study. Surgeons decided the reduction or suspension of capecitabine when adverse effects were found. Pharmacists instructed the patients of the way of intake and side effects. Nurses instructed the patients how to make skin care with brochure and DVD. We called to or made an interview to the patients once a week in the first eight weeks of administration by evaluating the symptoms of HFS. Finally, a questionnaire was taken to evaluate the degree patients’ satisfaction. All of the ten patients continued the skin care in the study. HFS above grade 2 appeared in three cases, and early decision of reduction or suspension of capecitabine was achieved as the result of support by telephone call or interview. Support by either telephone call or interview by nurses in the medical team of chemotherapy can contribute to the completion of chemotherapy by capecitabine by detecting the HFS in the early stage which leads to the early decision of reduction or suspension and by reduce the anxiety of the patients. We also suggest the necessity of the construction of individualized support system to the patients in the future.

View full abstract

Background: We set up a team to take charge of preparing and providing “meals to support minds” for patients in a palliative care unit when it was established in April, 2012. Method: We examined the data of 82 patients who left the palliative care unit from April 2012 to March 2013. National registered dietitians visited the patients on regular and temporary bases to assess their dietary intake and meal preferences. Result: A total of 76 kinds of dishes and foods were requested; 27 kinds of dishes related to the staple food, 12 kinds of main dishes, 13 kinds of side dishes, 18 kinds of fruits, desserts and beverages, and 6 kinds of pickles and dry seasonings. A total of 57% of the patients who died at the palliative care unit took their meals just before they died (0－7days before death). Conclusion: By allocating one dietitian per patient during the entire period of stay, who, besides visiting the patient once a week on a regular basis also made some additional visits, we were able to provide meals in accordance with the patients’ wishes and support their desire to eat until their last days.

View full abstract

【Background】From the time of establishment, management system of palliative care unit of cancer cooperation hospital in this community was created by consultation with regional home care agency. At the time of the current three－year establishment, its role is regarded as “acute palliative care unit with a hospice function”. In addition to the hospice function to perform hospice care for terminal cancer patients, with the aim of palliative care from early stage, it is an emphasis on functionality of acute palliative care unit (1.Symptom relief, 2.Decision support to patients and their families, 3.Adjustment and movement of the location of the medical treatment, 4.Adjustment of the support system at home care is difficult.) as a “second home” in the region for the “community hospice”. 【Result】As a result, over three years, hospitalized patient number, home transition number of patients, home transition rate, number of patients dying at home and home mortality were increased, but the average length of stay, readmission rates were reduced. 【Conclusion】In OPTIM－study, it is said that the ability to medical and welfare professionals involved in palliative care in the region is "meet" the opportunity, to be able to maximize the ability of the community, our palliative care unit establishment has become the opportunities in this community, cooperation with home care agencies deepened.

View full abstract

Purpose: The prefered location for recuperation of cancer patients is constantly changing. In order to meet the request of the patients and their family that they want to stay at home, our answer is to provide a “back-up bed” on the role for our palliative care unit. We developed a 24-hr hot line (Bethel Hospice Hotline; HL), and carried out HL from April 2010. For the purpose of future enhancement of cooperation, we examined the case of HL history over 3 years. Methods: Palliative care physicians interviewed patients and their families, explained the mechanism of cooperation to their family doctors. With their consent patients were registered to the HL. Results: 75 cases of HL registration from April 2010 to April 2013, 63 cases were supported by home care supporting clinics, 7 by other clinics, 3 by other hospitals and 2 others. The demands of family doctors upon HL: 69 cases were back bed and 14 cases required consultation for symptom relief. Our results show 42 (21 were emergency) patients admitted to our hospital, 18 received care at home supported family doctors, 4 were admitted to other hospitals, and 11 are ongoing. Conclusion: Since half of the admissions (21/42 cases, 6 were off hours) to our hospital were emergency, it is necessary to promote efficient cooperation to reduce the burden of the family doctors and the palliative care unit. Thus, it is expected to relieve the symptoms from early stages of the illness and to facilitate timely hospitalization.

View full abstract

Purpose: With a decreasing degree of independence in excretion movement, terminally-ill cancer patients experience an emotional distress and a lower sense of self-esteem. We herein report a case in which a patient received an effective excretion care by a palliative care team. Case: A female patient in her 60s was diagnosed with lung cancer and multiple bone metastases. On admission, she maintained her basic ADL (Activities of Daily Living) and walked independently; following a fall in the bathroom, however, she sustained a pathological fracture in the left humerus that was treated conservatively from a prognostic point of view. Despite concerns about pain and fracture risks during her trips to and from the bathroom, she wanted to excrete “on the toilet.” Out of respect for her wish and sense of pride, we gave her movement, lifting, and undergarment operation trainings in addition to adequate pain control. We also adjusted the equipment and increased the carers for her. With a gradual worsening of pain and a decline in ADL, she nevertheless had been able to perform excretion movement until the last moment when she was placed under sedation. Conclusion: This case suggests that an effective excretion care is possible by team approach respecting patients’ QOL and sense of dignity.

View full abstract