Introduction: We report a case of sudden loss of consciousness due to hypoglycemia in the terminal stage of cancer. Case: A 73-year-old man underwent craniotomy in 2016 and was diagnosed with solitary fibrous tumor. In 2022, his brain tumor recurred and he was admitted to our hospice. On the morning of the 120th day after transfer, the patient suddenly developed impaired consciousness. Blood tests showed hypoglycemia (33 mg/dL), and intravenous glucose injection improved his loss of consciousness, leading to a diagnosis of impaired consciousness due to hypoglycemia. After various examinations, hypoglycemia due to extrapancreatic tumor (non-islet cell tumor hypoglycemia: NICTH) was strongly suspected. Discussion: NICTH is considered to be caused by excessive secretion of an insulin-like substance (high molecular weight insulin-like growth factor (IGF-)II) from the tumor. In patients who are exposed to hypoglycemia for a long period of time, central nervous system symptoms such as impaired consciousness may suddenly develop without sympathetic symptoms. NICTH should be considered as a differential diagnosis in patients with delirium, impaired consciousness, or convulsive seizures and a large tumor, although it is not easy to prove the excessive secretion of high-molecular-weight IGF-II, especially in the terminal stage of cancer.

Purpose: To determine how nurses perceive the need for advance care planning (ACP) for chronic heart failure with patients and their families. Methods: A questionnaire survey was administered with 427 nurses who were affiliated with implantable cardioverter-defibrillators and resynchronization therapy. The survey included 13 items related to the need for ACP for simulated advanced heart failure cases with patients and their families. Results: Valid Responses were obtained from 207 nurses. On out of all items, the least proprtion of participants (51%) responded “giving predictions about functional prognosis and life expectancy” should be performed with patients. The participants’ perceptions regarding 8 items, which included the items on communication about prognosis, reflected their belief that ACP should be performed with family members rather than the patient. It was found that participants with certification in chronic heart failure nursing were more likely to respond in favor of ACP being performed with the patients in relation to 7 items, which included “ask about what has been important in one’s life”, and being performed with the family in relation to 10 items that included “ask the family what kind of life you want the patient to have hereafter”, as compared to other nurses. Conclusion: Regarding ACP, it is suggested that nurses are careful in discussing prognosis with patients, and certified nurses tend to attach importance to the individualities and values of patients and their families.