Objective: To evaluate outcomes of palliative surgery for malignant bowel obstruction (MBO) and identify factors associated with postoperative survival. Methods: We retrospectively reviewed 27 patients who underwent palliative surgery for MBO between April 2014 and March 2023. Clinical data including symptom relief, oral intake, discharge status, and overall survival (OS) were analyzed. Results: Median age was 70 years; 23 patients were Stage IV. Primary tumors included colon-rectum (15), stomach (6), pancreas (2), and others (4). Peritoneal dissemination was present in 18 cases. Median preoperative Palliative Prognostic Index (PPI) was 3.0. Postoperative symptom relief was achieved in 96.3%, oral intake in 81.5%, and discharge in 51.9%. Median OS was 118 days. Peritoneal dissemination and oral intake status were significantly associated with OS; sex, age, and PPI were not. Conclusion: Palliative surgery may improve outcomes such as symptom relief, oral intake, discharge to preferred care settings, and survival. These findings support its role in advance care planning and enhancing quality of life in patients with terminal cancer.

Purpose: The proportion of terminally ill cancer patients who were discharged home from a hospice/palliative care unit and subsequently died either at home or in the palliative care unit, whose final place of death was consistent with their intended place of care, remains unclear. This study aimed to clarify the consistency between the preferred and actual place of death. Methods: This study was a supplementary study to a multi-institutional bereavement survey conducted in 2018. Results: Responses were obtained from the bereaved families of 202 patients who died at home and 157 patients who died in a palliative care unit. Among them, 80% of home deaths and 82% of palliative care unit deaths were consistent with the stated end-of-life care preference. Among the 22 cases who preferred to die in a palliative care unit but died at home, the most common reason was the availability of physicians and nurses who could provide end-of-life care at home. Among the 11 cases who preferred to die at home but the patients died in a palliative care unit, the most common reason was insufficient pain management at home. Conclusion: Approximately 80% of patients died by their end-of-life care preference, suggesting that many were able to die in their preferred location.

The aim of this study is to clarify the outcomes of blood culture tests in patients with advanced cancer receiving hospice care. A total of 527 patients who took blood culture tests between April 2021 and March 2024 at our palliative care unit were included in the study. The rate of multiple blood culture set collection, positivity rate and contamination rate were 73.4%, 22.5% and 2.6%, respectively. The most-frequently-isolated pathogen was coagulase-negative staphylococci (28.8%). The rate for antimicrobial-resistant bacteria was 4.5%. Among the positive patients, 79.2% were administered appropriate antimicrobial regimens based on the drug susceptibility tests. The most frequently used antimicrobial as targeted therapy for bacteremia was vancomycin (31.5%). Despite their short lifespans, we conclude that blood culture test can be beneficial for patients receiving palliative care. Further observational studies are required to clarify characteristics of infectious diseases in terminally-ill patients with advanced cancer.

Objective: This study retrospectively examined the practice of chlorpromazine (CPZ) administration for sleep disturbance in a palliative care unit, with particular attention to concomitant use of midazolam (MDZ). Methods: A total of 126 patients were reviewed. Among them, 98 patients who continued CPZ for three days or longer were evaluated for changes in nighttime sleep status using a sleep score and for daytime consciousness level. Results: MDZ was used concomitantly in 99 patients (78.5%). Adverse events related to CPZ were observed in 12 patients (9.5%), mainly oversedation and extrapyramidal symptoms, while no severe circulatory or respiratory suppression was noted. Among the 98 patients who received CPZ continuously for three days or longer, sleep scores showed an improving trend; however, some patients experienced decreased daytime alertness, and the possibility that adverse events were underestimated cannot be excluded. Conclusion: This study was a retrospective, single-center analysis based on medical records and therefore has limitations related to the subjectivity of assessment tools and clinical judgment. Further prospective studies using standardized evaluation scales are required to establish the efficacy and safety of CPZ for sleep disturbance.

This study investigated the psychological impact of autopsy imaging (Ai) on bereaved families of patients with terminal cancer. These patients, one with pancreatic cancer of the body and tail and the other with intrahepatic cholangiocarcinoma, underwent Ai, and a mixed-methods survey was conducted with 7 bereaved family members using a self-administered questionnaire. Although the awareness of Ai was low (14.3%), all participants reported that Ai helped them understand the cause of death. Moreover, 71.4% felt that Ai was necessary. Qualitative analysis of free-text responses suggested that Ai contributed to a clearer understanding and acceptance of the cause of death and provided psychological reassurance. On the other hand, it became evident that the implementation of Ai could evoke emotional conflict and complex feelings in bereaved families. Therefore, confirming the patient’s wishes and providing psychological support to both the patient and their family are essential when conducting Ai. In the future, it will be essential for medical professionals to carefully explain the purpose and significance of Ai during advance care planning discussions, and to consider its implementation while respecting the wishes of both the patient and their family.

Introduction: Recent advances in cancer therapy have enabled long-term survival even in patients with advanced disease; however, chronic postoperative pain and other long-term treatment-related adverse effects have emerged as new challenges. Here, we report a case in which spinal cord stimulation (SCS) was introduced for post-thoracotomy pain syndrome (PTPS) following thoracic malignancy surgery, successfully achieving pain relief and opioid dose reduction in a patient with established opioid dependence. Case: The patient, a 32-year-old woman, developed persistent neuropathic pain after surgery. Some pharmacologic therapies were ineffective, leading to increased opioid use and eventual dependence. Following SCS implantation, pain improved with marked improvement in activities of daily living. Conclusion: SCS represents an effective option for intractable pain such as PTPS and may contribute to improved quality of life and reduced opioid reliance in cancer survivors.

Purpose: This study evaluated the effectiveness of a nursing intervention program to promote cancer pain self-management for outpatients using a non-randomized controlled trial. Methods: An intervention group underwent 3 sessions of the intervention program. The primary outcome measured was pain intensity (Japanese brief pain inventory [BPI-J]), and the secondary outcomes included the influence of pain on daily life, the effectiveness of pain relief treatment (BPI-J), quality of life (12-item short-form health survey [SF-12]), self-efficacy (pain self-efficacy questionnaire [PSEQ]), and psychological stability (hospital anxiety and depression scale [HADS]). Results: The data from 19 participants in the control and 16 in the intervention groups were analyzed. A comparison of changes in pain intensity before and after the study showed no statistically significant differences between the 2 groups. However, there was a statistically significant difference in the SF-12 role physical, with a decrease in the control group and an increase in the intervention group ( P=0.020). Conclusion: The only significant difference in the amount of change was found in the SF-12 role physical, and the intervention effect of this program could not be clarified. The reason for this was that the number of subjects was less than the sample size.

Purpose: To identify the bereavement care needs from medical professionals and the associated factors among cancer-bereaved family members who have experienced end-of-life care in general hospital wards. Methods: An online survey was conducted to assess the bereavement care needs among cancer-bereaved family members who have experienced end-of-life care in general hospital wards. Results: Four factors were found to be significantly associated with the need for bereavement care: “supporting family members to spend meaningful time together at the end of life” (odds ratio [OR]=3.17), “providing emotional support after bereavement, such as listening to the family’s story” (OR=4.70), “providing knowledge and information, including pamphlets to help people recover from grief” (OR=2.89), and “making a follow-up call after the patient’s death to make contact” (OR=2.84). Conclusion: Cancer-bereaved families in general wards need a continuum of care that enables meaningful end-of-life interactions and offers proactive emotional and informational follow-up. Integrating these elements into ward practice may reduce unmet needs and promote adaptive grieving.

This study elucidated the experiences of nurses facing challenges in assisting patients with breast cancer who are conflicted about revealing their diagnosis to their children. Seven nurses were interviewed to achieve the objectives of this study. The analysis focused on the nurses’ narratives regarding their struggles in providing support to patients with breast cancer. Following analysis, four categories were extracted from the data: “Insufficient time to support patients,” “Insufficient interprofessional coordination makes continuous involvement difficult,” “Unable to bring up the topic of explaining the illness to the child due to concern about the patient’s emotional burden,” and “Unable to intervene despite concerns that the child may realize the illness at the end, which could strain the parent-child relationship if the illness is not disclosed.” The nurses had anticipated and were concerned about the problems that would arise if the patient did not tell their child about their diagnosis and illness. However, the nurses did not have the courage to raise this topic with the patients. The findings suggest that to handle such situations, nurses should empathize with patients, understand the patients’ worries and desires, and collaborate to share patient information between medical professionals.

Objective: The Japanese version of Edmonton Functional Assessment Tool 2 (EFAT2-J) is a physical function assessment specifically for patients with advanced cancer. The purpose of this study was to examine the responsiveness of the EFAT2-J total score and to determine the clinical usefulness of the EFAT2-J. Methods: Participants were cancer patients who were being treated by a palliative care team and were not receiving curative treatment. Responsiveness was determined by comparing and correlating changes in the EFAT2-J and existing assessment scales up to approximately 2 weeks after the start of rehabilitation and calculating the standardized response means (SRM). Results: The participants were 31 patients with advanced cancer. The SRM of the EFAT2-J was large, and those of the existing assessment scales were moderate and small. Discussion: The EFAT2-J is an excellent physical function assessment that accurately captures changes in physical function in patients with advanced cancer.