Involvement of the pharmacy in home-based palliative care: a study involving patients who received sedative medications for pain relief

<b>Purpose</b>: We investigated the involvement of the pharmacy, as a health care resource that supports regional palliative care, in the treatment of patients who received continuous sedation during home-based care. <b>Method</b>: Of the home-based patients with end-stage diseases who received guidance for the management of home-based care between January 2011 and December 2012, this study involved 13 patients who were treated with sedation to relieve pain, and died at home. The survey items included the improvement of pain levels after the initiation of sedation, the number of prescriptions for sterile preparations, number of home visits made by physicians and pharmacists, and the change in the purpose of home visits made by pharmacists. <b>Result</b>: The improvement of pain levels was 76.9%. The number of prescriptions for sterile preparations and that of home visits made by physicians and pharmacists (per day) significantly increased after the initiation of sedation. Concerning the change in the purpose of home visits, an "emergency situation" became significantly more prevalent. <b>Conclution</b>: In the care of patients undergoing sedation at home, it is necessary to have physicians who can respond to emergency situations; thus, a similar system must be established for the pharmacy as a health care resource that supports regional care.

A case of nephrotic syndrome (NS) with advanced uterine cancer, in which the patient's QOL was greatly improved by treatment of NS

It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323