Purpose: The purpose of this investigation was to evaluate a suite of factors that may influence the use of gabapentin for the treatment of cancer pain in our hospital. Methods: We carried out a retrospective investigation of 52 patients hospitalized in our department with cancer-related neuropathic pain and under gabapentin treatment. Patients were divided into two groups: high dose (≥1,800mg gabapentin daily) and low dose (≤1,600mg gabapentin daily). The two groups were compared in terms of a suite of factors including patient background, type of neuropathic pain, dose of adjuvant analgesic drugs, period of administration, and the incidence of adverse effects. Results: Of the total number of patients involved in the study, 52% were in the high dose group. Patient age was significantly lower in the high dose group. There were no significant differences between the two groups in the dose of opioid analgesics, the number of adjuvant analgesic drugs, or the duration of administration. The incidence of adverse effects did not increase in the high dose group. Conclusion: In this retrospective investigation, we conclude that approximately half of our patient study population with cancer-related neuropathic pain may require daily gabapentin dose of 1,800mg or more. In addition, we observed that larger doses of opioid analgesics were used in the high dose group but without risk of increased adverse effects. This phenomenon may have been influenced by the lower patient age in the high dose group. Palliat Care Res 2010; 5(2): 219-226

In palliative care setting, betamethasone is commonly used to relieve various symptoms such as general malaise, loss of appetite, fatigue and pain. In patients administered steroids, the psychic adverse effects should be cared as well as the physical adverse effects. Profile of Mood States (POMS) is a tool to evaluate a temporary mood and an affective state of a patient. The contracted version of POMS shortens intervention time by reducing question items. We administered betamethasone 3mg/day to the patient with digestive symptoms by bowel obstruction and the symptoms improved. Four months later, as the patient complained anxiety, irritation and insomnia, we prescribe predonisolone switching from equivalent dose of betamethasone. In this case we experienced that psychic symptoms improved without worsening digestive symptom since three days after the drug change. We evaluated a mood and an affective state before and after the drug change by using POMS contracted version. Palliat Care Res 2010; 5(2): 332-337

Purpose: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. Case 1: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. Case 2: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. Conclusion: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.

Objectives: We compared cancer patients who were discharged home from inpatients hospices (Home), and who died at hospices (PCU) as a comparison group regarding patients’ quality of life, to clarify the patients’ experience after discharge home. Methods: We send self-reported questionnaires to bereaved families of cancer patients who were discharged home from 12 Japanese nation-wide hospices and died without readmission to the hospicies during Janually 2010 and August 2014. We used bereaved families’ data of patients who died at the same hospices during the same period of J-HOPE3 study. Results: We sent 495 questionnaires (returned 47.3%) and analyzed data of 188 as Home. The data of 759 bereaved families of J-HOPE3 study were also analyzed as PCU. In Good Death Inventory, Home was associated with higher score on some items (staying at favorite place, having pleasure, staying with families and friends, being valued as a person), and PCU was associated with higher score on being free from pain or other physical distress. Conclusions: Patients who were discharged home from inpatient hospices had good environmental QOL, but hospices may be better in palliation of symptoms.

The patient was an 81-year-old woman who had undergone TAVI (Evolut PRO® 26 mm) for severe aortic stenosis at our hospital approximately 6 months previously. She was discharged from the hospital without any postoperative complications, but at 6 months after the surgery, fever, back pain, and high inflammatory findings were observed. Based on lumbar spine MRI findings, the patient was diagnosed with pyogenic spondylitis and epidural abscess, and drainage surgery was performed. Enterococcus faecalis was identified from a blood culture. MRI of the head showed scattered subacute infarcts in the right frontal lobe, and transthoracic echocardiography revealed hyperintense deposits at the aortic valve leaflet, suggesting vegetation. The diagnosis of PVE was made and medical therapy was initiated. However, the vegetation gradually increased in size and mobility, and a surgical approach was indicated. A surgical procedure was performed through a median sternotomy to remove the prosthetic valve and replace the aortic valve. The postoperative course was good, with no recurrence of infection, and the patient was transferred to another hospital for rehabilitation on the 26th postoperative day. In general, TAVI patients are older and have more comorbidities, and surgery is associated with a higher degree of risk. However, radical surgery should be considered if medical therapy is not effective in PVE after TAVI. We reported a case of surgical aortic valve replacement for PVE after TAVI.