Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.

Objectives: To explore background factors contributing to learning needs among physicians in palliative care specialty training. Methods: We conducted a questionnaire survey of physicians in specialty training in palliative care who were within 15 years after medical school graduation. The unmet learning needs (referred to as “needs”) were evaluated on a 5-point scale. Factor analysis was performed to identify underlying subscales of needs. Univariate analysis was performed using an average score of each subscale as a dependent variable and background factors as independent variables. Results: Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. Factor analysis identified six subscales of the unmet learning needs: research, time, specialist, network, quality, and comprehensiveness. Background factors with significant between-group differences with the effect size of 0.4 or more included: 1) not working at a certified training facility, 2) not working or training at a big hospital, and 3) the number of palliative care physicians being 2 or less in the facility. Conclusion: Improvement of the training system is urgently needed for young physicians who are working at small or non-certified facilities for specialty training, or who have few palliative care colleagues.

Training system of palliative care in Japan has not been fully established, and young physicians’ needs for palliative care training are not nearly satisfied. We have recently conducted a nationwide survey to clarify unmet learning needs among Japanese physicians in specialty training in palliative care and the potential solutions they favored to meet those needs. Here we report findings of content analyses of free comments in the survey. Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. The content analyses from 80 physicians (35%) identified 162 codes with respect to needs for improvement which were further classified into 24 subcategories and 9 categories (e.g., contents of subspecialty training, certified facilities, research capabilities, learning environment and methods, system of board certification, and networking). These findings may help improve specialty training in palliative care in Japan.

We established the Early Palliative Care (EPC) outpatient department for patients who had received chemotherapy at other hospitals in August 2015. We retrospectively investigated medical records of patients who consulted the EPC outpatient department and patients who consulted the Medical Oncology outpatient department of our hospital between August 2015 and January 2016. The length of the first medical examination, the contents of the medical examination, period to hospitalization and period to death were investigated. Nineteen EPC outpatients and 11 Medical Oncology outpatients consulted a total of 80 times and 117 times at the respective outpatient department. The median length of the first medical examination in the EPC and Medical Oncology outpatient departments was 45 minutes (range, 10-106 minutes) and 38 minutes (range, 23-60 minutes), respectively (p=0.17). The contents of the examination in the EPC outpatient group included discussion about symptom management, coping, etc. Five patients (26%) in the EPC outpatient group passed away less than 60 days from the first medical examination. It would be possible for palliative physicians to establish and manage an EPC outpatient department in Japanese hospitals. However, some patients had late referral to the EPC outpatient department. Public awareness about EPC and the practice of EPC are important.

There are few reports on the disclosure of survival prediction to patients themselves in Japan, and how concretely it is performed. We retrospectively studied the disclosure of survival prediction to patients who were referred for the first medical examination to the Palliative Care Department between April 2013 and March 2016. Two hundred forty-eight patients (and their families) met the study criteria. Forty-three percent of the patients and their families had received information on definite periods of life expectancy without probability or ranges. On the other hand, 19% of the patients and families had not been told about survival prediction by the previous physician. Our results suggest that patients and families often received information on definite periods of life expectancy. There will be a need for improvement of end-of-life discussion in Japan.

Introduction: To our knowledge, there is only one report of lactic acidosis in a patient with prostate cancer and no such report in Japan. We describe a patient with terminal stage prostate cancer who showed marked elevation in lactate dehydrogenase (LDH) levels and lactic acidosis. Case Report: The patient was a 66-year-old man diagnosed with prostate cancer and bone and liver metastases. At the time of diagnosis, he was being treated with the best supportive care after chemotherapy and hormone therapy for prostate cancer. He was admitted to the hospital for nausea and loss of appetite. Laboratory tests showed elevated LDH levels (11,894 IU/L; LDH4, 23%; LDH5, 32%); pH, 7.402; pCO2, 13.2 mmHg; HCO3−, 8.0 mmol/L; and lactate level, 10.0 mmol/L. On the basis of the results, the patient was diagnosed with lactic acidosis. He showed tachypnea the day before his death. Conclusion: Elevation in LDH levels, and especially of LDH5, indicates acceleration of anaerobic glycolysis from tumor cells, leading to the accumulation of lactate. The patient’s tachypnea was possibly caused by lactic acidosis.

Currently, world-wide practice palliative care from early stage is underway. However, the practice has a variety of issues. “Palliative oncologist”- both trained Oncology and palliative care- have been proposed. Kawasaki municipal Ida hospital, from oncology ward, palliative care, and home in one sector and offers by using this system training programs have been conducted. Fellows can experience the anticancer treatment and palliative care. It may be useful Palliative oncologist training in Japan, and training program at our hospital would be a model.

Case: The patient was a man in his 40s who had undergone proctocolectomy for familial polyposis coli and extensive resection of the small intestine for removal of an intra-abdominal desmoid tumor. He presented to our hospital with abdominal pain caused by residual desmoid tumor, and diarrhea associated with the short bowel syndrome. Adequate pain control could not be achieved even with simultaneous application of 5 sheets of 100 μg/h transdermal fentanyl patches. Subsequently, the patient was treated mainly with 270 mg/day of a slow-release morphine preparation; however, the pain control remained unsatisfactory. At our hospital, the pain treatment was switched to 240 mg/day of morphine solution, which yielded prompt reduction of the pain intensity from 9/10 to 1/10 on the numerical rating scale. Discussion: Morphine is mainly absorbed from the small intestine. The initially insufficient pain control in this patient may have been attributable to the short bowel syndrome and diarrhea causing rapid excretion of the morphine before it was absorbed. Morphine solution, in contrast, starts to be absorbed approximately 10 minutes after administration, allowing adequate absorption, leading to successful pain control, even in the present patient with the short bowel syndrome.

Objective: Spinal cord compression symptoms are complications that greatly reduce the quality of life of cancer patients. We report a retrospective study on the efficacy of and adverse reactions to high-dose dexamethasone therapy for patients with concomitant spinal cord compression symptoms. Subjects: This study included 8 patients with concomitant spinal cord compression symptoms who received high-dose dexamethasone therapy at our hospital between May 2009 and September 2011. Results: Only high-dose dexamethasone therapy was performed in 8 patients who could not undergo radiotherapy or surgery in combination. Among them, the results of manual muscle testing were improved in 4 patients (50.0%), and grades according to the modified Frankel Classification showed improvement in 5 patients (62.5%). Out of 7 non-ambulatory patients, one (14.3%) regained independent ambulation with highdose dexamethasone therapy alone and was discharged home. No serious adverse reactions were observed in any of the 8 patients. Discussion: This study suggested high-dose dexamethasone therapy to possibly be a useful option for relieving neurological symptoms in patients with spinal cord compression who cannot undergo radiotherapy or surgery in combination.

Background: The demand for palliative care in Japan has risen over recent years, and training of palliative care physicians is an important problem. However, little is known about unmet needs for education and training systems as well as career development among young physicians who wish to specialize in palliative care. Purpose: To explore unmet needs among palliative care physicians in training. Method: We held group discussions in a forum for physicians of postgraduate year≦15, and analyzed their opinion on topics such as "what are unmet needs?" using theme analysis. Results: Forty physicians participated. Theme analysis revealed the following unmet needs among young physicians; "securing of manpower", "securing of quality of training programs/education", "improvement of network", "removal of many barriers to keeping on a palliative care physician", and "establishment of career models for a specialist". Conclusions: We should discuss solutions for the unmet needs to secure more palliative care physicians.