Purpose: Nausea is a common distressing symptom experienced by advanced cancer patients. This study compared the clinical efficacy of haloperidol to hydroxyzine hydrochloride in combination with haloperidol in the management of nausea induced by continuous infusion of opioids. Methods: This retrospective study comprised 50 advanced cancer patients using continuous infusion of opioids who had been administered either haloperidol alone (haloperidol group) or hydroxyzine hydrochloride with haloperidol (hydroxyzine hydrochloride group); their nausea and characteristics were assessed using multivariate analysis. Results: After the continuous infusion of opioids, nausea occurred in 34% patients in the haloperidol group and 10% patients in the hydroxyzine hydrochloride group. No significant differences were observed in patient characteristics, except for the number of the patients using infusion of opioids. By multivariate analysis, nausea before using continuous infusion of opioids, ileus, and haloperidol without hydroxyzine hydrochloride were extracted as the risk factors of nausea. In both the groups, nausea occurred only in the patients using morphine; nausea occurred in 32.5% patients in the haloperidol group and in 4.5% patients in the hydroxyzine hydrochloride group. Conclusion: Hydroxyzine hydrochloride in combination with haloperidol was observed to be more effective than haloperidol alone in the management of nausea induced by continuous infusion of opioids.

Self-expandable metallic stent (SEMS) was used for five unresectable patients with malignant colorectal stenosis. The SEMS was successfully inserted under a colonoscopy. The patients were able to maintain bowel activities without any serious complications during the rest of their lives. In conclusion, SEMS placement for malignant colorectal stenosis would be safe and effective.

Purpose: Paracentesis is one of the most effective techniques to manage malignant ascites in cancer patients. Some patients require frequent repeated drainage because of a rapid reaccumulation of ascites. The indwelling catheter technique is proposed to avoid the procedure risks and complications. Case report: We report a case of 73-year-old male diagnosed pancreatic cancer. The central venous catheter was used for management of his malignant ascites. One liter of ascetic fluid was removed every day for 21 days until death. To prevent a clogging of the catheter, multiple side-holes were opened to the catheter in advance of the paracentesis, and medical cyanoacrylate adhesive (Aron Alpha®) was applied around the indwelling catheter to avoid the leakage of ascites. Conclusion: We propose the use of the central venous catheter for the drainage of ascites, because the technique is less invasive and inexpensive, and also can reduce such complications as a clogging of the catheter and fluid leakage.

The purpose of this study was to develop the "Itamikei", a small machine which records the subjective level of pain between 0-10. In addition to testing it's ease of operation and usefulness in the clinical practice environment. The "Itamikei" is 23 cm x 6 cm x 2 cm. It weighs 160 grams. It has 11 buttons, relating to the 0-10 Numeric Rating Scale (NRS). Each time a button is pushed the level of pain is recorded, along with the time and date. Later, this data can be transferred to computer displayed graphically showing the patient's subjective level of pain. This research was a case study for using the "Itamikei". One in-patient at the university hospital who had cancer pain was asked to use the "Itamikei" for 14 days. A graph was printed out and given to both the patient and the medical staff.
The results suggest the following:
1. Using the 0-10 NRS the patient could easily express her level of pain.
2. Because the "Itamikei" was easy to operate, the patient found no difficulty in entering her level of pain.
3. In graph form the daily transition in pain levels can be easily analyzed, and a program for managing pain can be prepare.

We surveyed the involvement of hospice and palliative care staff in spiritual and life-and-death education at school. We sent a questionnaire to a total of 138 hospice and palliative care institutions, receiving 67 responses (response rate 49%). A variety of staff at 15 institutions (22%) practiced life-and-death education. Most often, they realized the necessity of such education when they observed children grieving from the death or dying of a family member. 6 institutions targeted their life-and-death education to primary schools, 8 to junior high schools, and 6 to senior high schools. The number of teaching sessions ranged from once to 97 times per year, with hours of class contact less than one hour in 2 institutions, and 1-3 hours in the other 12 institutions. Even those institutions not conducting school education almost all responded that school education on life and death by healthcare workers would be meaningful. Respondents concurred that children would be moved by both "life-and-death education" and "spiritual education." Further comments almost all noted the importance of life-and-death education, not only for children but also for adults. In this sense, the expertise and experiences of hospice and palliative care institutions will become valuable educational resources.

Purpose: The purpose of this study was to develop and evaluate a training program for facilitators operating a support group (SG) for cancer patients. Methods: The training program was structured and implemented as a two-day program for members of the nursing profession with experience in providing care for cancer patients. An original questionnaire, developed to ascertain knowledge regarding SG operation, and for evaluating anxiety and self-efficacy was designed for use before and after going through the program to allow for comparative evaluation. The subjects of this analysis were 58 nurses taking part in the program. Results: As a result, the knowledge of how to operate SG increased significantly (p<0.05) following participation. Of the 12 items addressing anxiety and self-efficacy regarding SG operation, lessening of anxiety was noted in 3 items, and self-efficacy was seen to improve significantly in 7 items. Motivation and resolve concerning SG operation following participation in the program also increased significantly. Conclusion: This was a useful training program for facilitators operating support groups for beginners.

Purpose: The aim of this study was to evaluate the influence of informing patients of the endpoints of palliative chemotherapy on the quality of care for terminally ill cancer patients. Methods: Of 85 advanced cancer patients who died at our hospital during the last 2 years, 53 patients who received palliative chemotherapy were recruited for this study. The patients were divided into three groups based on whether disease status and treatment endpoints were explained to the patient before the chemotherapy: group A; both the disease status and treatment endpoint were explained, group B; only the disease status was explained, and group C; neither were explained.Japanese version of Support Team Assessment Schedule (STAS-J) was used to evaluate the quality of care for the patients. Results: Of the 53 patients, 17, 22, and 14 cases were assigned to group A, group B, and group C, respectively. Changing gear, that is, stopping palliative chemotherapy followed by palliative care, was well accepted by 88%, 41%, and 0% of group A, B, and C patients, respectively (p<0.01). By using the STAS-J, it was revealed that there were no significant differences in either symptom control or in anxiety among the groups, but there were significant differences in insight of advanced disease and communication to others (p<0.001). Conclusion: When performing palliative chemotherapy in advanced cancer patients, they should be informed of its endpoint before beginning the chemotherapy. This will lead to successful ′changing gear, ′ and improvement of the quality of care for terminally ill cancer patients.

Purpose: In Japan, the daily dosage limit of acetaminophen is considered to be 1500mg: however, in Europe and the USA, the daily dosage limit of acetaminophen for patients with cancer pain is 4000 mg. In Japan, only 100 mg and 200 mg acetaminophen suppositories are available, which means that cancer pain patients may need to insert up to 3 - 4 acetaminophen suppositories at the same time. Therefore, in this study, we examined the efficacy of 600 and 800 mg suppositories prepared at our hospital. Methods: We measured the serum concentrations of acetaminophen in cancer pain patients prescribed either oral or the rectal formulation of acetaminophen, and examined the side effects of the drug. Results: Our results revealed similar mean blood concentrations of acetaminophen in both the oral and rectal group of patients, and the serum AST, ALT and total bilirubin levels were within normal range in all the cancer pain patients prescribed acetaminophen. Conclusion: Our results suggest good bioavailability of acetaminophen from the acetaminophen suppositories in our cancer pain patients.

Purpose: Pruritus is a rare symptom among advanced cancer patients. This rarity results in limited knowledge about its mechanisms and treatments. Moreover, many previous studies have proposed pharmacological interventions to alleviate pruritus of not malignant disease but chronic liver disease (e.g. primary biliary cirrhosis). Recently, the antipruritic activity of paroxetine has been reported in various systemic disease. Case report: We report a case of 72-year-old female diagnosed hepatocellular carcinoma with liver cirrhosis. On admission, although jaundice was detected on her conjunctiva and skin with high serum total bilirubin level 3.4mg/dL (direct bilirubin 2.3mg/dL), she did not complain of pruritus. Gradually, she suffered from pruritus with no exanthema on her entire skin and perceived no beneficial effect from H1-antihistamine and topical steroid administrations (symptom score 7/10). Significant antipruritic effect was achieved immediately with oral paroxetine 10mg on day 13. On day 14, she scored pruritus on whole body at 0/10, and this antipururitic effect was observed for 2 weeks after administration until her death. No adverse effects were reported. Conclusion: Paroxetine is an antidepressant agent classified selective serotonin reuptake inhibitors. The antipruritic activity of paroxetine is possible due to the involvement of changing itch signal from peripheral serotoninergic receptor to central nervous system and inhibiting the enzyme activation (CYP2D6) of endogeneous opioids as pruritogens. We have observed the beneficial effect of paroxetine to alleviate pruritus due to malignant jaundice.

Purpose; Recurrent laryngeal nerve paralysis (RLNP) is often observed in terminal cancer patients. It causes hoarseness of voice, and this interferes with a patient's communication skills. Moreover, RLNP causes aspiration, which decreases the joy of eating, and pneumonia. Although it is important to control the symptoms of RLNP in terminal cancer patients, there are few methods for their control. In this study, 3 terminal cancer patients suffering from RLNP were treated using percutaneous intrafold silicon injection. Methods; The injection was administered under local anesthesia through cricothyroid membrane monitoring fiberscopy. The amount of silicon to be injected was determined on the basis of fiberscopic findings; 0.4 to 2.0 ml of silicon was injected. Results; As a result of this treatment, a marked improvement in voice hoarseness and swallowing ability was observed in all 3 cases. No complications were observed during and after treatment. Conclusion; Thus, percutaneous intrafold silicon injection is a very useful and safe treatment for RLNP in terminal cancer patients.