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.

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.

Purpose:This study aims to clarify the current situation where palliative care is concurrently performed with cancer therapy, and its effectiveness. Methods:Medical charts of patients cared for at home between April 1, 2012 and March 31, 2013 were retrospectively investigated. Results:14 out of 192 home-care cancer patients were given chemotherapy. The palliative medication period was 192 days and chemotherapy lasted 89.8 days on average. From the beginning of home palliative care until death, patients received chemotherapy for almost half of this period. Consideration:By establishing trust between patients and caregivers, palliative care serves the patients needs well, even after cancer treatment is completed. Home palliative care is a significant part of the entire process.

At Anjo Kosei Hospital, patients receive injectable medication for diabetes treatment and devices for self-monitoring of blood glucose as in-hospital prescriptions. Pharmacists manage prescriptions according to established protocols when there is over- or under-prescribing. In this study, we retrospectively examined outpatient prescriptions for patients attending endocrinology and diabetology from January 2014 to June 2015 (before protocol implementation) and from July 2015 to December 2020 (after protocol implementation) to evaluate the usefulness of protocol-based supporting prescription by pharmacists. Changing prescriptions based on the protocol simplified prescription queries in 661 of 721 cases (91.7%), and significantly decreased the rate of unplanned doctor visits after the introduction of the protocol (p<0.05). Optimization of prescriptions through protocol-based assistance in prescribing is expected to reduce the burden on physicians, patients, and pharmacists by reducing the number of formal inquiries for questionable prescriptions and the number of unplanned doctor visits.