ABSTRACT
Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physician experiences were rated using a 5-point Likert-type scale. Results: Responses were received from 553 physicians (187 in Okinawa, 219 in Tohoku, 147 in the Tokyo metropolitan area). In Okinawa, “When patients die, it is important that all family members are present at the last moment,” “Patients/family members primarily consult the elders of the family about the medical treatments,” “Family members hope the patients die at home, because the soul will not return when they die at the hospital,” “Patients/family members get advice from religious advisors about the medical treatments,” and “Family members wish to take the patient home when he/she is about to die and to confirm death at home” were significantly more frequently observed. In Tohoku, “Patients wish to be hospitalized at a specific season” was significantly more frequently reported. In Tohoku and Okinawa, “Patients hide cancer from neighbors and relatives” and “Elderly patients do not want treatment, because they cover the living expenses and education expenses for their children and grandchildren.” were significantly more frequently experienced. Conclusion: There are regional differences in cancer and palliative care in Japan. Being sensitive to the culture of the region is needed.
ABSTRACT
<b>Purpose</b>: Some patients with cancer pain are relatively less responsible to opioids, and require other strategies to improve the balance between analgesia and adverse effects. In those patients, the usage of some adjuvant analgesic drugs is recommended with opioid analgesics according to the first step of the WHO ladder for cancer pain relief. Recently, the efficacy of gabapentin for several cancer-related neuropathic pain has been reported. <b>Case report</b>: We present the case of a 64-years old female patient who had extensive vertebral bone destruction of C1-C2 due to metastasis of multiple myeloma, complicated with acute tetraplegia. Invasion to the retropharyngeal space by tumor enlargement seemed to increase the risk of upper airway obstruction. When our palliative care team first met her, she was suffering from the severe nape pain with allodynia at her right shoulder and incurable headache, refractory to intravenous morphine hydrochloride administration of 100mg/day (numerical rating scale; NRS 7/10). Her chief physician was negative against the dose escalation of the opioid analgesics, because of the risk of respiratory depression. Significant analgesic effect (NRS 3/10) was immediately achieved with oral gabapentin 900mg/day on day1. On day5, after gabapentin was increased up to 1,800mg/day, her nape pain was remarkably reduced to NRS 1/10, and no adverse effect was reported. <b>Conclusion</b>: For patients who are relatively naïve to increase of opioid analgesics, the supplementary use of adjuvant analgesic drugs would be favorable to both objectives; fewer adverse effects and reduction of the pain. Palliat Care Res 2009; 4(1): 301-306