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.

Objective: To determine the factors influencing the necessity of holding death conferences. Methods: Data of 416 cancer patients who died in the palliative care unit of the National Cancer Center Hospital East between August 2013 and February 2015 were reviewed. Patients’ medical charts and data sheets of conferences held after their deaths were analyzed. Results: A total of 25.7% of participants saw the necessity of holding death conferences. Multiple logistical regression analyses revealed four independent factors that influenced the holding of death conferences: age <50 years; length of stay in the palliative care unit ≥20 days; epidural analgesia; aphonia; and abdominal distention. Conclusion: These factors might explain nurses’ difficulty in providing end-of-life care for cancer patients.

The effects of a fan to reduce dyspnea have been evaluated in several trials worldwide, however, there has been no clinical report in terminal cancer patients in Japan. We conducted a retrospective chart review to examine whether a fan is useful for dyspnea in terminally ill cancer patients. We reviewed medical and nursing records and selected all patients（n＝9）who received a fan from July 2013 and January 2014. The primary outcome measure was a decrease dyspnea measured by a visual analogue scale（VAS；0＝no shortness of breath, 100＝worst shortness of breath）. There was a significant difference in the VAS score after treatment with the fan（40.2±11.8 versus 15.6±14.9, P＝0.004）. Our results suggest that a fan may help in reduces the sensation of dyspnea in patients with terminal cancer. Future prospective study is needed.

Objectives: To clarify the content of death conferences. Methods: 60 death conferences held in the palliative care unit of the National Cancer Center Hospital East between May 2012 and November 2014 were analyzed in a retrospective study. Medical records and notes from the time of the meeting were used. Results: 170 units of data were abstracted from the death conferences held during the studied period. These data were categorized into five groups: 1. supporting family members as subjects of care, 2. understanding and cherishing patient’s thoughts, 3. reducing symptoms and relieving pain, 4. realizing the importance of communication between medical personnel, and 5. becoming anxious due to interaction with patients. Conclusion: The results suggest that the death conference is a useful opportunity to look back on support from various perspectives and directions.

Objective: This study aimed to elucidate the sense of self-usefulness among patients with advanced cancer receiving chemotherapy in ambulatory care. Methods: Semi-structured interviews were conducted with 20 patients regarding their desire to contribute to others, their everyday lives, and changes in their roles. The text was subjected to qualitative content analysis. Result: Five themes as the sense of self-usefulness finally emerged: “contribution to others,” “approval from oneself and others,” “value given to existence,” “maintenance of independence,” and “integration of life.” Conclusion: The findings suggest that the sense of self-usefulness among patients with advanced cancer who are undergoing chemotherapy is complex. It involves concerns about their independence being threatened and their awareness of the limited time remaining, alongside the looming specter of death amid the worsening and progression of their disease.

Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Objective: Almost half of all patients with cancer experience dyspnea, which can have various causes. Although systemic corticosteroids are administered to relieve symptoms, their efficacy has not been established. This systematic review aims to determine the efficacy of systemic corticosteroids for dyspnea in patients with cancer. Methods: CENTRAL, MEDLINE, EMBASE, and Ichushi-Web databases were searched for articles published from their inception to September 23, 2019, on studies of systemic corticosteroid administration for dyspnea in patients with cancer. The primary outcome measure was dyspnea intensity, as assessed by patient-reported outcomes. Secondary outcome measures were quality of life, delirium, and severe adverse events. Results: Two RCTs were included in the meta-analysis. With regard to alleviating dyspnea, the systematic corticosteroid group was associated with significantly greater dyspnea relief than the placebo group (mean difference: −0.71 [95% CI: −1.4 to −0.03]). However, a meta-analysis of quality of life and delirium could not be performed due to insufficient data. Analysis of severe adverse events showed no significant difference in their incidence between the corticosteroid and control groups (relative rate: 0.96 [95% CI: 0.19-4.93]). Conclusions: Systemic corticosteroids may be effective in treating dyspnea in patients with cancer, particularly those with lung involvement. Limiting the conditions for which corticosteroids are approved is expected to promote their appropriate use and minimize their adverse effects. However, further investigation is needed to determine the appropriate dosage, and the conditions in which corticosteroids are effective.