Objective: To evaluate outcomes of palliative surgery for malignant bowel obstruction (MBO) and identify factors associated with postoperative survival. Methods: We retrospectively reviewed 27 patients who underwent palliative surgery for MBO between April 2014 and March 2023. Clinical data including symptom relief, oral intake, discharge status, and overall survival (OS) were analyzed. Results: Median age was 70 years; 23 patients were Stage IV. Primary tumors included colon-rectum (15), stomach (6), pancreas (2), and others (4). Peritoneal dissemination was present in 18 cases. Median preoperative Palliative Prognostic Index (PPI) was 3.0. Postoperative symptom relief was achieved in 96.3%, oral intake in 81.5%, and discharge in 51.9%. Median OS was 118 days. Peritoneal dissemination and oral intake status were significantly associated with OS; sex, age, and PPI were not. Conclusion: Palliative surgery may improve outcomes such as symptom relief, oral intake, discharge to preferred care settings, and survival. These findings support its role in advance care planning and enhancing quality of life in patients with terminal cancer.

Purpose: The proportion of terminally ill cancer patients who were discharged home from a hospice/palliative care unit and subsequently died either at home or in the palliative care unit, whose final place of death was consistent with their intended place of care, remains unclear. This study aimed to clarify the consistency between the preferred and actual place of death. Methods: This study was a supplementary study to a multi-institutional bereavement survey conducted in 2018. Results: Responses were obtained from the bereaved families of 202 patients who died at home and 157 patients who died in a palliative care unit. Among them, 80% of home deaths and 82% of palliative care unit deaths were consistent with the stated end-of-life care preference. Among the 22 cases who preferred to die in a palliative care unit but died at home, the most common reason was the availability of physicians and nurses who could provide end-of-life care at home. Among the 11 cases who preferred to die at home but the patients died in a palliative care unit, the most common reason was insufficient pain management at home. Conclusion: Approximately 80% of patients died by their end-of-life care preference, suggesting that many were able to die in their preferred location.

The aim of this study is to clarify the outcomes of blood culture tests in patients with advanced cancer receiving hospice care. A total of 527 patients who took blood culture tests between April 2021 and March 2024 at our palliative care unit were included in the study. The rate of multiple blood culture set collection, positivity rate and contamination rate were 73.4%, 22.5% and 2.6%, respectively. The most-frequently-isolated pathogen was coagulase-negative staphylococci (28.8%). The rate for antimicrobial-resistant bacteria was 4.5%. Among the positive patients, 79.2% were administered appropriate antimicrobial regimens based on the drug susceptibility tests. The most frequently used antimicrobial as targeted therapy for bacteremia was vancomycin (31.5%). Despite their short lifespans, we conclude that blood culture test can be beneficial for patients receiving palliative care. Further observational studies are required to clarify characteristics of infectious diseases in terminally-ill patients with advanced cancer.

Objective: This study retrospectively examined the practice of chlorpromazine (CPZ) administration for sleep disturbance in a palliative care unit, with particular attention to concomitant use of midazolam (MDZ). Methods: A total of 126 patients were reviewed. Among them, 98 patients who continued CPZ for three days or longer were evaluated for changes in nighttime sleep status using a sleep score and for daytime consciousness level. Results: MDZ was used concomitantly in 99 patients (78.5%). Adverse events related to CPZ were observed in 12 patients (9.5%), mainly oversedation and extrapyramidal symptoms, while no severe circulatory or respiratory suppression was noted. Among the 98 patients who received CPZ continuously for three days or longer, sleep scores showed an improving trend; however, some patients experienced decreased daytime alertness, and the possibility that adverse events were underestimated cannot be excluded. Conclusion: This study was a retrospective, single-center analysis based on medical records and therefore has limitations related to the subjectivity of assessment tools and clinical judgment. Further prospective studies using standardized evaluation scales are required to establish the efficacy and safety of CPZ for sleep disturbance.

In this study, we conducted interviews with staff members who had experience in discharge coordination to clarify the characteristics and efforts of discharge coordination for patients with pediatric cancer toward end-of-life. Focus group interviews were conducted with 11 individuals, including six medical social workers and five nurses (acceptance rate: 84.6%) and a qualitative inductive analysis was conducted. Seven categories were identified as characteristics of discharge coordination for patients with pediatric cancer toward the end-of-life, such as “few home physicians and home health care nurses who could accept terminally ill children” and “a small number of cases and lack of accumulated experience”. Seven categories were identified as efforts of discharge coordination, including “maintaining connections with the community” in three situations: coordination with home physicians and home-visit nursing care, coordination with children and their families, and coordination in hospitals. The number of children who spend their end-of-life days at home is increasing, and we believe that it is necessary to consider expanding the role of pediatric cancer base hospitals in the future, such as collecting information in the community and sharing good practices.

Objective: This study aimed to clarify the preferred place for end-of-life care and the perceptions of palliative care among elderly people living in areas with a high aging rate and limited healthcare resources. Methods: A questionnaire survey was conducted in June 2022, one and a half years after the palliative care team (PCT) was established, in a community with an aging population of over 40%. Results: Among 1,298 patients aged 65 years or older, 475 (36.6%) provided valid responses. Of these, 317 (66.7%) expressed a preference to spend as much time as possible at home for end-of-life care, and 157 (49.5%) indicated that it would be difficult to spend their final days at home. In addition, 277 (58.3%) of respondents had heard about palliative care, and 437 (92.0%) had never heard of PCT at the hospital. Conclusion: Our findings revealed the preferred place for end-of-life care and awareness of palliative care among elderly people living in areas with a highly aging population and limited healthcare resources. It is necessary to promote palliative care in hospitals and develop a collaborative system with community healthcare providers.

Purpose: Owing to the increasing mortality rate in Japan, basic nursing education on the end-of-life care is essential. This study determined the educational learning outcomes of the angel care practice that involves angel makeup based on the reflective descriptions of nursing students. Methods: About 87 students enrolled in the “Seminar in Adult Nursing Practice (Nursing at the End-of-Life: Angel Care)” course at Iwate Medical University School of Nursing in June 2021 consented to participate in the present study. After experiencing the roles of patient, family member, and nurse in the angel care practice, the participants reflected on the care they provided to the patients and their families. Their descriptions on the practice sheets were analyzed to determine the learning outcomes of the angel care practice. Results: “Awareness of the importance of angel care,” “understanding angel care through practice,” and “motivation and concerns as a nurse” were the learning outcomes of the angel care practice for nursing students. Conclusion: The practice that incorporates angel care along with lectures provides nursing students with an opportunity to learn ways to maintain their patient’s dignity.

Introduction: Calciphylaxis is a rare disorder characterized by painful ischemic skin ulcers. There is currently no approved therapy and its pain management is often challenging. Case: A 40-year-old female was diagnosed with calciphylaxis seven years after starting hemodialysis. Despite the administration of sodium thiosulfate intravenous and intralesional combination therapy, the ulcers progressed on both lower limbs and buttocks. She suffered from terrible and opioid refractory pain due to ulcers. After careful consideration of the appropriateness, a lumbar sympathetic ganglion block (LSGB) was performed. Six months later, all the ulcers had re-epithelialized and she was relieved of pain. Conclusion: While the appropriateness of LSGB must be carefully evaluated, it could be a treatment option for patients with central-type calciphylaxis.

Background: Despite the significant physical, emotional, and financial burdens faced by the families of cancer patients, such as caregiving, assisting with hospital visits, and supporting social activities, research on their quality of life (QOL) remains insufficient. Objective: To evaluate the QOL of the families of patients undergoing chemotherapy for cancer and to investigate its relationship with the patients' treatment courses. Methods: A prospective analysis was conducted using EORTC-QLQ-C30 to measure the QOL of patients with unresectable or recurrent solid tumors and their families. Assessments were performed before first-line treatment and before second-line treatment in patients treated at our department between 2016 and 2024. Changes in QOL over the treatment periods and the impact of treatment efficacies were examined. Results: A total of 45 patients were included. Family members frequently reported fatigue, pain, insomnia, and financial difficulties both before and after treatment. Emotional and cognitive functioning declined to the same extent as in patients and did not recover over time. Social functioning notably reduced during the early treatment phase. Treatment efficacy had no impact on the QOL of family members. Discussion: The survey using self-administered questionnaires revealed the consistent need for emotional support for families and highlighted the importance of early social support during the treatment phases.

Introduction: Carotid sinus syndrome is rarely associated with head and neck malignant cancer. We usually have no effective treatment for carotid sinus syndrome in terminal stage of cancer. We experienced a case in which continuous explanation of his condition and lifestyle guidance resulted in alleviation of syncope attacks. Case: A 73-year-old male who was diagnosed with oropharyngeal cancer and with multiple lymph node metastases in the neck. Dizziness and syncope attacks occurred to him due to carotid sinus syndrome. He was referred to the outpatient department of palliative medicine, then he and his wife received explanation of his condition and lifestyle guidance of avoiding triggers and of how to avoid syncope attacks at the onset of prodomal symptoms. The frequency of attacks decreased and he resumed his daily walk. However, attacks without triggers began to occur to him seven months after the intervention started. Although he continued to stay at home, he was hospitalized due to difficulty in body movement and died the next day. Discussion: Explanation of his condition and lifestyle guidance were useful for management of syncope attacks because the syncope attacks had triggers and prodomal symptoms. The interventions including lifestyle guidance improved his quality of life and let him stay at home.