Purpose: Nausea is a common distressing symptom experienced by advanced cancer patients. This study compared the clinical efficacy of haloperidol to hydroxyzine hydrochloride in combination with haloperidol in the management of nausea induced by continuous infusion of opioids. Methods: This retrospective study comprised 50 advanced cancer patients using continuous infusion of opioids who had been administered either haloperidol alone (haloperidol group) or hydroxyzine hydrochloride with haloperidol (hydroxyzine hydrochloride group); their nausea and characteristics were assessed using multivariate analysis. Results: After the continuous infusion of opioids, nausea occurred in 34% patients in the haloperidol group and 10% patients in the hydroxyzine hydrochloride group. No significant differences were observed in patient characteristics, except for the number of the patients using infusion of opioids. By multivariate analysis, nausea before using continuous infusion of opioids, ileus, and haloperidol without hydroxyzine hydrochloride were extracted as the risk factors of nausea. In both the groups, nausea occurred only in the patients using morphine; nausea occurred in 32.5% patients in the haloperidol group and in 4.5% patients in the hydroxyzine hydrochloride group. Conclusion: Hydroxyzine hydrochloride in combination with haloperidol was observed to be more effective than haloperidol alone in the management of nausea induced by continuous infusion of opioids.

Self-expandable metallic stent (SEMS) was used for five unresectable patients with malignant colorectal stenosis. The SEMS was successfully inserted under a colonoscopy. The patients were able to maintain bowel activities without any serious complications during the rest of their lives. In conclusion, SEMS placement for malignant colorectal stenosis would be safe and effective.

Purpose: Paracentesis is one of the most effective techniques to manage malignant ascites in cancer patients. Some patients require frequent repeated drainage because of a rapid reaccumulation of ascites. The indwelling catheter technique is proposed to avoid the procedure risks and complications. Case report: We report a case of 73-year-old male diagnosed pancreatic cancer. The central venous catheter was used for management of his malignant ascites. One liter of ascetic fluid was removed every day for 21 days until death. To prevent a clogging of the catheter, multiple side-holes were opened to the catheter in advance of the paracentesis, and medical cyanoacrylate adhesive (Aron Alpha®) was applied around the indwelling catheter to avoid the leakage of ascites. Conclusion: We propose the use of the central venous catheter for the drainage of ascites, because the technique is less invasive and inexpensive, and also can reduce such complications as a clogging of the catheter and fluid leakage.

　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.

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.

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.

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.

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.

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.

【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.