Extended－release Oxycodone tablet has been available for cancer pain treatment since 2003 in Japan. After pure oxycodone injection became available in 2012, we have tried to switch from oral to injection when oral intake becomes difficult because of bowel obstruction, nausea or drowsiness due to progression of the disease. There is no evidence regarding the ratio of switching from oral to injection at present in Japan. We always pay attention to avoid patients drowsiness because of an overdose of opioid, because there is not enough time left for cancer patients in the terminal stage, and drowsiness takes away from the patient’s good QOL. We switched Oxycodone from oral to injection in 8 cases from June to December in 2012. At first, we assess if the patient is well controlled by oral oxycodone or not. If the patient is not relieved from the pain enough, we switch oxycodone from oral to continuous subcutaneous injection with a dose of around 75％ at first. After that we titrate the dose little by little up to an appropriate level. We were able to evaluate 5 patients out of 8 because there were 3 patients with consciousness disorder. As a result, we were able to decrease dosage to 46.4％ on average.

In Palliative care, we meet patients with easy-bleeding superficial malignant tumors, such as head and neck cancer, skin metastasis of all kinds of cancer and unresectable breast cancer. But it is not easy to control bleeding even though we use various means, and many doctors have difficulties in stopping bleeding. We report a case with a recurrent tumor of pharyngeal cancer that showed easy-bleeding and discharged massive exudates. Although she received several alcohol local injections because of bleeding of the tumor, she needed a dressing change over 5 times in a day. It made her QOL worse. In this case, we used Mohs paste and after using it, the surface had been fixed and dried up, resulting in a decrease in bleeding, exudate, frequency of dressing change and bad odor. Mohs paste was made of distilled water, zinc chloride, zinc starch and Glycerol. Zinc chloride changes to zinc ion by water in the wound and makes protein cohere and thereafter tissues, vessels and cell membrane of bacteria are fixed chemically. We could stop bleeding for 15 days with only 20 minutes contact with Mohs paste, and massive exudates and bad odor decreased. Mohs paste, which is made in your hospital pharmacy with cheap materials, can be used for bleeding or massive exudates repeatedly if there is not a thick blood vessel anatomically under the tumor. It was effective to improve her QOL. Palliat Care Res 2009; 4(2): 346-350

We devised IMADOKO as a tool to confirm the current status of terminal cancer patients and are using it in the home care team. In this study, we retrospectively investigated the actual state of end-of-life care to clarify the impact of IMADOKO on decision-making support for terminal cancer patients and their families. The subjects were 64patients (male/female, 38/26) before IMADOKO introduction, and 140 patients (male/female, 78/62) after the introduction, with an average age of 74 years in both cases and the primary lesions were the pancreas, lung, and the gastrointestinal tract. The rate of death at home increased significantly after the introduction of IMADOKO, compared to before. In the IMADOKO introduced group, IMADOKO was used in 108 patients and all their families. The use of IMADOKO for the patient was not related to the location of death, but it significantly improved communication between the patient and family, and between patient/patient's family and medical staff. It was shown that IMADOKO may be useful for decision-making support in choosing a better place of recuperation.