The effects of a fan to reduce dyspnea have been evaluated in several trials worldwide, however, there has been no clinical report in terminal cancer patients in Japan. We conducted a retrospective chart review to examine whether a fan is useful for dyspnea in terminally ill cancer patients. We reviewed medical and nursing records and selected all patients（n＝9）who received a fan from July 2013 and January 2014. The primary outcome measure was a decrease dyspnea measured by a visual analogue scale（VAS；0＝no shortness of breath, 100＝worst shortness of breath）. There was a significant difference in the VAS score after treatment with the fan（40.2±11.8 versus 15.6±14.9, P＝0.004）. Our results suggest that a fan may help in reduces the sensation of dyspnea in patients with terminal cancer. Future prospective study is needed.

Purpose：This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. Methods：We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. Results：The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. Conclusion：This study demonstrated the current state of home palliative care by specialized home care clinics.

The aim of this study is to clarify the diet and complementary and alternative medicine among terminal cancer patients followed at home. A cross-sectional survey of bereaved families of 200 cancer patients who were received home care by 5 palliative care clinics in Kobe in 2014. The response rate was 66％. The average age of the patients was 74 years old. The family members received the information about diets from books, magazines, and newspaper（48％）and medical staff（46％）. The patients actively took in tea（64％）, dairy（62％）, and soy（60％）. The patient avoided alcohol（49％）, fat（31％）, and salt（31％）. The question asking the complementary and alternative medicine（CAM）, 32％ respondents answered using CAM, of which 28％ took mineral supplements, and vitamins. Due to the paucity of the evidence about the diet and CAM for cancer patients, the patient and family tend to practice the general diet therapy.

Objective：There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services. Method：We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. Results：The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. Conclusion：The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.

Purpose：The purpose of this study was to clarify the practice of acupuncture and moxibustion in medical institutions with a palliative care unit. Methods：A selfadministered questionnaire was mailed to the physicians in charge of the ward or the chief nurses of 244 medical institutions with a palliative care unit. Results：Responses were obtained from 98 institutions. Among these, it was obvious that acupuncture and moxibustion therapy were performed in six institutions（6.1％）. The conditions of patients treated with acupuncture and moxibustion were pain, fatigue, constipation, and displeasure. Regarding acupuncturists being concerned with a palliative care field, it was described that acupuncturists could have one of the important role in clinical field in palliative care. On the other hand, it was indicated that there were difficulties associated with the practice of acupuncture and moxibustion therapy in a hospital. Conclusion：Although acupuncture and moxibustion therapy are considered to have usefulness as a variety of care, to practice acupuncture and moxibustion therapy in a medical institution, it is necessary to examine create the practice system.

For the purpose of relieving stress caused by post operative change in diet due to gastric cancer, a cancer salon which included a cooking class collaborating with doctors, oncology certified nurse specialist, NST registered dietitian, cancer support center nurse, and cook was held. The cancer salon was intended for post gastrectomy patients and their families. There were total of 20 participants（12 patients, 8 families, 8 males and 12 females）, and among them were six couples. We conducted a questionnaire survey of cancer salon to participants whose average age was 64±13.4 years old. All participants responded“good”or“fair”in all items. Among respondents, 61％（n＝11）said it was fun, 88％.（n＝15）said“cooking in the cooking class would be helpful in the future”. Not only learning how to cook, the salon provided an opportunity for participants to interact with each other and exchange information. In addition it helped participants to realize that there are others having the same disease who want to exchange opinions and the disease is not a problem of an individual rather it exists more universally.

Purpose：Although ammonia shows a high due to advanced liver failure and the development of portal vein collateral circulation, there are few reports on ammonia in terminal stage of cancer. Therefore, the blood ammonia was measured against terminally ill cancer patients were studied retrospectively. Methods：For 80 cases who were admitted to the hospital for the purpose of palliative care, measured the blood ammonia at the time of admission, we have studied cancer species, gender, age, survival period, HbA1c, albumin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, blood urea nitrogen, prothrombin activity, estimated glomerular filtration rate, C-reactive protein, hematocrit, presence or absence of liver metastases, presence or absence of opioid, laxative use, L3 level psoas major muscle area in ammonia high-value group and the normal group. Results：Hyperammonemia in terminally ill cancer patients in average survival time 41.6 days was observed in 21.3％. The significant differences in gender and liver metastasis in univariate analysis, liver metastases were extracted in the logistic regression. Conclusion：Cancer terminally ill patients with liver metastases were significantly higher to exhibit hyperammonemia in this study.

Objective:To report a case of serotonin syndrome induced by an interaction between fentanyl and amoxapine in a patient treated for cancer pain. Case:A 37-year-old woman with recurrence of cervical cancer was treated with oxycodone and etodolac for her cancer pain in the gluteal region. She developed acute abdominal pain and received emergency surgery under the diagnosis of upper gastrointestinal tract perforation.Continuous fentanyl infusion was initiated during surgery and was continued postoperatively to control postsurgical and cancer pain. The route of fentanyl was changed to transdermal patch the next day, and dose was escalated during the following days in attempt to control her gluteal pain. Eight days after the operation, amoxapine was prescribed as an adjuvant analgesic. Five days later, the fentanyl dose was further escalated to 2100μg/day. The following day, the patient developed tremors of the extremities, confusion and hallucinations, followed by fever and involuntary movements of the lower extremities. Amoxapine was discontinued and the symptoms subsided within 4 days.Conclusion:Co-administration of a tricyclic antidepressant and high doses of fentanyl precipitated serotonin syndrome in this patient.

Introduction: Goshuyuto was effective in a case with intractable hiccups caused by the medulla oblongata dissemination of the cerebellum melanoma. Case:A 54-yearold male patient was diagnosed cerebellum malignant melanoma. He suffered from intractable hiccups caused by the medulla oblongata dissemination lesion of this melanoma. He was treated with some Western medicines such as Baclofen, Metoclopramide, Chlorpromazine and Clonazepam, which are usually used for the treatment of hiccups, but they were not effective. Therefore we gave him Goshuyuto which is Kampo medicine and his hiccups subsided immediately. Since then, he continues taking Gosyuyuto about a year and there has been no recurrence of hiccups thus far. Conclusion: Taking of Kampo medicine is the useful choice for a patient whom Western medicine is ineffective.

Objectives: Primary aim of this study was to clarify the family evaluation about caring the body of the deceased patient by nurses at Japanese inpatient hospices and palliative care unit. Method: A mail survey was performed on 958 bereaved family members of 103 palliative care units in July, 2010. Result: A total of 597 family members replied（62％）. As a whole, 441（74％）families reported that they were satisfied with the way caring the body of the deceased patient by nurses. A multivariate analysis revealed three factors were significantly associated with the levels of satisfaction:the patient face became peaceful and calm, and nurses treated the patient in the same way before died, and patient age was over 70 years old. Conclusion: Making patient face peaceful and calm, and treating the patient in the same way before died is important in caring the body of the deceased.