Background and Purpose: Nursing healthcare-associated pneumonia (NHCAP) causes distress and unpredictable symptoms. We investigated the frequency of comorbid symptoms and the effects of symptom relief with pharmacotherapy for NHCAP patients with advanced cancer. Methods: We retrospectively investigated the medical records of 15 patients with NHCAP who had died from January 2014 to November 2015. We investigated the frequencies of symptoms (pain, dyspnea, drowsiness, respiratory secretions, nausea, insomnia, fever, dry mouth, wheezing, and depression) and the therapeutic effects of drugs for symptom management (opiates, glucocorticoids, anti-cholinergic agents, and antibiotics). A Validated instruments (Support Team Assessment Schedule-Japan [STAS-J]) was used to assess symptom distress. Results: The symptoms of NHCAP were pain, insomnia, fever, fatigue, oral feeding difficulty, dry mouth, nausea, drowsiness, and depression. Administration of opioids was a useful treatment for dyspnea and pain. The mean number of concurrent symptoms was 4.6 ±1.8. Opioids and glucocorticoids were administrated to patients with pain and dyspnea, and these symptoms were resolved. Antibiotics were used in all patients, who were resolved their wheezing and fever, but no other symptoms. Conclusions: Patients with advanced cancer complicated by NHCAP have multiple distressing symptoms. A focus on ameliorating the most prevalent physical symptoms and psychological distress may improve overall quality of life in this patient population.

Case 1: A female, aged 81 years, with cardiac stomach cancer. Air retention in the digestive tract aggravated discomfort of the epigastric region, but belching relieved the symptom. As belching insufficiency persisted, the continuous subcutaneous injection of metoclopramide was started. Belching was promoted, and swelling of the upper abdomen was relieved. Case 2: A male aged 57 years. Gastrointestinal obstruction related to pancreatic head cancer was observed. He complained of discomfort of the upper abdomen with abdominal swelling. Belching reduced these symptoms. The continuous subcutaneous injection of metoclopramide facilitated belching, and relieved discomfort of the upper abdomen.Discussion： The results suggest that the continuous administration of metoclopramide is a useful option for belching insufficiency associated with cancer-related gastrointestinal obstruction. In the presence of gastrointestinal obstruction,gas retained in the stomach may be elevated/regurgitated through the peristalsis-promoting actions of metoclopramide,promoting belching.