Although palliative sedation therapy (PST) is considered to alleviate intolerable and refractory symptoms in dying patients with advanced cancer, there have been few studies regarding the situation of tertiary cancer center. We conducted a retrospective survey of the medical records of the patients who died between April 2015 and March 2016 at the National Cancer Center Hospital in Japan. PST was conducted in 75 out of 431 patients (17.4%). The patient demographics were as follows: sex (male/female), 48/27; median age, 61 years (range 5-83; 11 patients (14.7%) were aged under 39 years); and primary sites were lung, 18 (24.7%)/ pancreas, 11 (14.7%)/ hematopoietic organs, 11 (14.7%)/ bones and soft tissues, 8 (10.7%)/ and the others, 27 (36.0%). The main target symptoms for PST were dyspnea (38, 50.7%) and delirium (30, 40.0%). The most commonly used sedative agent was midazolam (72, 96.0%). Continuous deep sedation was intended in 61 patients (81.3%) at the death. Median survival from the start of PST were 2 days (range 0-54). The differences between palliative care team (PCT) intervention group and control group were lower age (58 vs. 62.5, P=0.048) and uniformity of initial midazolam dose (5-12 vs. 9.6-25.2 mg/day). Distinctive feature in this study was large proportion of adolescent and young adult patients with rare cancers. PCT might have different approaches to sedation in comparison to non-PCT medical staffs.

Few pregnant women are prescribed oxycodone for cancer pain. Here, we report a case of neonatal abstinence syndrome in an infant born to a woman using oxycodone long term for cancer pain. During pregnancy, rather than the expected effects on pregnant women for oxycodone use, fetal growth was also favorable. However, the infant presented with respiratory failure after birth and required ventilator management. In addition, the infant required treatment for neonatal abstinence syndrome.

Introduction: Our palliative care staff began the support activity in opioid introduction for outpatients with cancer at Komaki City Hospital in March 2018, because it was difficult to make them understand about proper use of opioid analgesics and misinterpretation about abuse at the time of opioid introduction in outpatient settings. This study aimed to evaluate the effects of the activity (patient education on pain control, telephone follow up, and assessment of the symptom). Method: Outpatients with cancer receiving strong opioids for pain relief from January 2017 to March 2019 were eligible. We retrospectively investigated the difference of the variables between baseline and after the activity as follows; the ratios of prescribing immediate-release opioids, antiemetics, and laxatives when opioids were prescribed and side effects due to opioid analgesics appeared. Results: The study included 122 patients. The prescribing ratios of immediate-release opioids antiemetics and laxatives all increased from 90.7 to 98.5%, from 63.0 to 70.6%, and from 61.1 to 70.6%, respectively. The side effect incidence due to opioids with STAS-J 2 or more decreased from 12 (22.2%) to 9 (13.2%). Discussion: The activity could contribute to the provision of drug treatments and counselling needed for opioid therapy.

Purpose: To elucidate the actual state of difficulties and related factors of nurses in caring for patients with recurrent and metastatic malignant musculoskeletal tumor. Methods: The subjects were 315 nurses from 12 institutions that treat malignant musculoskeletal tumor. We researched the difficulties of nurses regarding cancer nursing and care of patients with malignant musculoskeletal tumor. We examined the related factors by multiple regression analysis. Result: 165 nurses responded (effective response rate 52.4%). Among “Nurses’ difficulty with cancer care”, the level of difficulty regarding communication was the highest and in own knowledge/technology, system/regional cooperation was also high. Among “Nurses’ difficulty with care for patients with malignant musculoskeletal tumor”, there was a high degree of difficulties regarding the target characteristics of care. Related factors were facility characteristics, nursing experience, nursing experience of musculoskeletal tumor, learning methods for musculoskeletal tumor nursing, and multi-professional conferences. Conclusion: Nurses caring for patients with malignant musculoskeletal tumor have specific difficulty due to total pain, age of onset, and rarity. Educational support based on related factors is therefore required.

The aim was to explore existential suffering n physicians caring for terminally ill cancer patients. We performed qualitative analyses of 30 physician-reported descriptions of the clinical experience of caring for terminally ill cancer patients. Analyses were conducted using descriptive phenomenology to clarify the meaning of physicians’ experiences, guided by the three dimensions of Murata’s human being model. In their descriptions, all physicians mentioned existential suffering related to incompetence, and three themes were identified: 1) physicians who focus on the limitations of what they can achieve with curative or palliative treatment feel a sense of incompetence; 2) physicians who focus on difficulties in caring for patients with existential suffering feel a sense of incompetence; and 3) physicians who focus on environmental factors, such as work overload and insufficient communication skills training, experience a sense of incompetence. Physicians experience a sense of incompetence when they face treatment limitations and/or difficulties in caring for patients with existential suffering.

Purpose: Naldemedine is a peripheral µ-opioid receptor antagonist, including the treatment of opioid-induced constipation (OIC) . However, diarrhea is known as its side effect. We conducted a study focusing on the administration period of opioid analgesics before the start of naldemedine to clear predictors of diarrhea due to Naldemedine. Method: All data were retrospectively collected from the electronic medical record system. We investigated patients who initially administrated naldemedine at Nagasaki University Hospital from June 1 2017 to March 31 2019. Result: One hundred thirty-two patients were subject of investigation. The incidence of diarrhea was 25.0%. The result of the multivariate analysis showed that significant predictors of diarrhea were associated with the opioid analgesics usage period longer than 7 days before naldemedine initiation (odds ratio: 3.76, 95% confidence interval: 1.53-9.20, p=0.004). Discussion: When naldemedine was used for OIC, diarrhea may be avoided by using within 7 days after opioid analgesics.

Objectives: The study purpose was to examine quality-of-life (QOL) of pediatric cancer patients at end-of-life and related factors using a QOL proxy rating scale from the nurse’s perspective. Methods: We conducted a survey in October 2015−February 2016. The subjects to be surveyed were nurses who were primarily in charge of patients with childhood cancer at end-of-life. We investigated 22 items of the Good Death Inventory for Pediatrics (GDI-P) and their related factors. Results: In total, 53 proxy evaluate questionnaires were completed from 18 centers. Among the eight factors of GDI-P, “Relief from physical and psychological suffering” was the lowest. The total score of GDI-P was positively correlated with the structure and process of care (r=0.58). Although there was a bias in the number of cases, in the case of the place of death was the intensive care unit, the total score of GDI-P was lower than home and the general ward. Conclusions: It was suggested that the top priority in improving QOL was relief from suffering and the structure and process of care were related to QOL.

We report a case of refractory cancer pain that was successfully treated with opioid switching by adding methadone to the preceding opioid. A 38-year-old man had severe epigastric pain and back pain because of paraaortic lymph node metastasis of a gastroesophageal junctional carcinoma. His pain was treated with continuous intravenous morphine administration and the frequent use of a rescue dose. When the morphine dose was increased, respiratory depression developed; thus, his pain was considered refractory to the morphine, and methadone was added on. The pain was relieved after initiating methadone, and the frequency of the rescue dose was markedly decreased. The methadone dose was gradually increased in parallel, and the morphine dose was reduced and finally discontinued. No methadone-induced side effects were noted, and the patient was discharged with good analgesia. In our case, adding methadone without decreasing the preceding opioid dose under strict monitoring made it possible to stably switch the opioid without increasing pain.

Objective: The aim of this study is to elaborate on the nutritional intervention in a multimodal intervention (the NEXTAC-ONE program) for the elderly with advanced cancer and to evaluate its tolerability Methods: We prospectively recruited patients aged ≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three nutritional intervention were planned in 8-week study period. The nutritional counseling consists of standard nutritional advice, evaluation and support for nutrition impact symptom, and evaluation and support for eating-related distress and food environment problems. We also provide the oral nutritional supplements rich in Branched Chain Amino Acids (BCAA). Results: 29 patients (96%) of a total of 30 study registrants participated in all three nutrition interventions. Median proportion of days in which patients recorded a nutritional diary was 90%. Median consumption of supplements was 99 %. There was no adverse event associated with nutritional intervention. Conclusions: Our nutritional intervention program showed an excellent compliance in the elderly with advanced cancer patients, and our data indicated a potential protective effect on nutritional deterioration.

Background: We experienced two cases where fentanyl relieved pregnant women of their cancer pain. Case 1: A pain in the lower back of a 30-year-old woman since the 30th week of her pregnancy for multiple myeloma. We started fentanyl continuous intravenous infusion on the first day of the 34th week and gradually increased the dosage to 32 μg/h. Elective cesarean section was performed on the 1st day of week 36. The child was born without problems. Case 2: A 34-year-old woman was diagnosed with stomach cancer in the 22nd week of her pregnancy. Fracture on the twelfth thoracic vertebra was also found. Continuous-subcutaneous-infusion of fentanyl was started and the dosage was escalated to 24 μg/h , which reduced her pain. Chemotherapy was effective for her cancer and did not affect the fetus. At week 34, elective cesarean section was carried out. Because the child presented cyanosis immediately after birth, tracheal intubation was performed, but extubated on the next day without problem. Conclusion: Fentanyl was found to be effective for reducing cancer pain in the two cases. Although the existence of causal relationship is unknown, cyanosis was observed in one case.