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.

Purpose: The purpose of this study was to clinically implement an advance care planning (ACP) program using existing communication tools between patients and healthcare providers, and to clarify the effectiveness of the intervention. Methods: Cancer patients admitted to 2 departments at a local designated cancer hospital, as well as doctors and nurses, were divided into 2 groups: 9 people in the usual care group (control group), and 9 people in the intervention group utilizing the ACP program using an instruction manual, etc. Then, 6 items related to implementation status, and the effect of the ACP program were analyzed. Results: Regarding the implementation of the ACP program, the implementation rate was 42% (T1, 1 month later), 0% (T2), and 33% (T3). The effect of the ACP program was that discussion between healthcare providers and patients and families (P=0.0027) and care aligned with patient goals (P=0.0027) were significantly higher in the intervention group. Conclusion: By presenting specific behavioral indicators as an ACP program, this study served as a trigger for general ACP behavior among both patients and healthcare providers.

Objective: To identify effective strategies to provide high-quality palliative care in settings where palliative care specialists are scarce, particularly in Japan. Methods: A scoping review of literature (in English) was conducted using Arksey and O’Malley’s methodological framework. Electronic databases (MEDLINE, CINAHL, and the Cochrane Library) were searched and supplemented with a manual search of relevant journal articles. Results: Nine studies met our inclusion criteria. Four key strategies have emerged: (1) developing a video consultation system to improve the timeliness of care; (2) providing online consultations by specialists to support general practitioners; (3) training nurses to manage the palliative care process; and (4) transferring knowledge and information from experts to non-specialists. Conclusion: Based on these strategies, creating a system tailored to the specific needs and readiness of palliative care in Japan is necessary. The effectiveness of these strategies should be evaluated in future research.

Purpose: This study aimed to a geographic accessibility, including patient coverage, of facilities providing specialized palliative care in Hokkaido. Methods: Vital statistics and digitized geographic information were used as data. We estimated the number of patients in need of palliative care, including both cancer and non-cancer patients, based on estimated by Murtagh et al. and the mortality statistics for Hokkaido. We analyzed the coverage rate within a 16 km radius of specialized palliative care facilities, as well as the distances and travel times to these facilities. Results: Cancer patient coverage within the 16 km radius, with hospitals providing specialized palliative care as the main purpose of coverage, was 77.2%. Patient coverage, including noncancer patients, in home-based palliative care facilities was 83.2%. The average time for cancer patients to arrive at the nearest hospital providing specialized palliative care varied from 9.7 to 197.0 minutes, with regional differences. Discussion: We assessed geographic accessibility to specialized palliative care in Hokkaido. In the future, we suggest the need for optimal allocation of medical facilities and collaboration between hospitals and home care to improve equity of specialized palliative care provision.

Background: The National Cancer Center Institute for Cancer Control has trained regional palliative care coordinators to disseminate personnel promoting collaboration between cancer hospitals and regional institutions. We examined the effectiveness of the training. Methods: A questionnaire survey was conducted in February 2022 among facilities participating in the training sessions from 2016 to 2021. Results: One-hundred sixteen facilities responded. The results were classified as ‘positive change (78%)’ and ‘negative change (0%)’. Regarding ‘factors inhibiting the smooth transition of terminal cancer patients from hospital to home,’ ‘patients’ social background (e.g., living alone, old age, etc.) interferes with the transition to home care (88%)’ and ‘patients’ anxiety about home care (83%)’ were the most common factors. Conclusion: Nearly 80% of participants reported positive changes, indicating that the training has had a certain effect. With regard to inhibiting factors, we plan to consider how training should be conducted so that it can address the individual issues in each region.

Introduction: Autonomic and psychiatric symptoms occur in opioid withdrawal syndrome. We report a case in which a patient treated with hydromorphone for cancer pain showed psychiatric symptoms similar to withdrawal syndrome and improved with divided administration of an extended-release tablet formulation. Case: A 60-year-old woman who underwent surgery for left breast cancer. She had been treated with hydromorphone, non-opioid analgesics, analgesic adjuvants, and nerve blocks for pain due to recurrence of lumbar metastases. However, before regular oral administration of hydromorphone extended-release, symptoms of anxiety, irritability and restlessness began to appear. Since these symptoms improved a few hours after the regular administration, we suspected the effects of opioids on blood concentration and changed the dosage to twice-daily divided doses of the same drug. As a result, symptoms decreased dramatically. Conclusion: When patients experience withdrawal-like psychiatric symptoms while taking opioids, it may be possible to alleviate these symptoms by considering the effects of decreased blood levels and adjusting the dosage of the drug, such as divided dosing.

Objective: We conducted two workshops to encourage “Jinsei Kaigi” to discuss advance care planning (ACP) with family members or significant others during healthy times and evaluated whether the workshops were effectively motivated participants to engage in ACP. Methods: Two workshops were held with 171 welfare commissioners, and four surveys were conducted (T1-T4) before and after the workshops. The primary endpoint was the rate of “Jinsei Kaigi” implementation, and the secondary endpoints were the Japanese versions of the ACP Engagement Survey (ACPES-J), which measures readiness for ACP, and Death Attitude Inventory (DAI), which were compared before and after the intervention, with T1 VS. T4 as the primary analysis. Results: A total of 149 participants were analyzed, and the implementation rate was 38.3%, which was a significant increase from 6% before implementation (p<.001, w=.54). Self-efficacy, readiness, and ACPES-J total scores increased significantly (p<.001 to .031, d=.29 to .67, respectively), but there were no significant changes in DAI. Conclusion: Our results suggest that workshops provide opportunities to motivate engagement in “Jinsei Kaigi”.