Terminal Anguish among Delirious Patients with Advanced Cancer: A Multicenter, Prospective, Observational Study

Objective: This study aimed to reveal the prevalence and characteristics of anguish among delirious patients with advanced cancer receiving specialized palliative care services. Methods: We conducted a subanalysis of a multicenter, prospective, observational study at 14 inpatient palliative care units and 10 general wards that offered psycho-oncology consultation service in Japan. We consecutively enrolled the patients with advanced cancer who were diagnosed with delirium and prescribed antipsychotics. Palliative care specialists decided whether patients suffered from anguish or not. We assessed patients’ background and severity of delirium with the Delirium Rating Scale-Revised (DRS-R-98). Results: Of 818 enrolled patients, 99 (12.1%) suffered from anguish. We observed a significant difference in the mean age (68.9±12.6 vs. 72.1±11.2, p=0.009), prevalence of dementia (2% vs. 10.4%, p=0.005) between patients with anguish and those without anguish. Patients with anguish had lower DRS-R-98 total scores before medication than those without anguish (15.3±8.1 vs. 17.3±7.8, p=0.018), but higher severity score in lability of affect (1.2±0.8 vs 1.0±0.9, p=0.023). Conclusions: The results of this study suggested that patients with anguish tend to be younger, mostly do not have dementia, and have lower delirium severity score but higher score in lability of affect. Nevertheless, further research, investigating appropriate evaluations and medical interventions for patients with anguish is warranted.

Additive effect of rikkunshito, an herbal medicine, on chemotherapy-induced nausea, vomiting, and anorexia in uterine cervical or corpus cancer patients treated with cisplatin and paclitaxel: results of a randomized phase II study (JORTC KMP-02) / 부인종양

OBJECTIVE: Rikkunshito, an herbal medicine, is widely prescribed in Japan for the treatment of anorexia and functional dyspepsia, and has been reported to recover reductions in food intake caused by cisplatin. We investigated whether rikkunshito could improve chemotherapy-induced nausea and vomiting (CINV) and anorexia in patients treated with cisplatin. METHODS: Patients with uterine cervical or corpus cancer who were to receive cisplatin (50 mg/m² day 1) and paclitaxel (135 mg/m² day 0) as first-line chemotherapy were randomly assigned to the rikkunshito group receiving oral administration on days 0–13 with standard antiemetics, or the control group receiving antiemetics only. The primary endpoint was the rate of complete control (CC: no emesis, no rescue medication, and no significant nausea) in the overall phase (0–120 hours). Two-tailed p<0.20 was considered significant in the planned analysis. RESULTS: The CC rate in the overall phase was significantly higher in the rikkunshito group than in the control group (57.9% vs. 35.3%, p=0.175), as were the secondary endpoints: the CC rate in the delayed phase (24–120 hours), and the complete response (CR) rates (no emesis and no rescue medication) in the overall and delayed phases (63.2% vs. 35.3%, p=0.095; 84.2% vs. 52.9%, p=0.042; 84.2% vs. 52.9%, p=0.042, respectively), and time to treatment failure (p=0.059). Appetite assessed by visual analogue scale (VAS) appeared to be superior in the rikkunshito group from day 2 through day 6. CONCLUSION: Rikkunshito provided additive effect for the prevention of CINV and anorexia.

The evaluation of management of pain in elderly cancer patients receiving home-based care : the questionnaire with online system

Since bibliographic items had an error, it corrects as follows. <BR><BR>p.158, upper right of a page<BR>(Error) Palliative Care Research 2012; 8(1): 158-67<BR>(Correct) Palliative Care Research 2013; 8(1): 158-67<BR><BR>p.158, center of a page<BR>(Error) Palliat Care Res 2012; 8(1): 158-67<BR>(Correct) Palliat Care Res 2013; 8(1): 158-67<BR><BR>p.164, center of a page<BR>(Error) Palliat Care Res 2012; 8(1): 158-67<BR>(Correct) Palliat Care Res 2013; 8(1): 158-67

A survey of the death attitude of pharmacy students finished clinical training using the Death Attitude Inventory

<b>Purpose</b>: Pharmacists should play a positive role in palliative care. The pharmacy curriculum should also contain content promoting an appropriate attitude toward death. Hence, this study aims to gather fundamental information that can be used to understand the various death attitudes held by pharmacy students. <b>Methods</b>: We targeted 159 sixth-year students of the School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, in 2011. They studied "Up-to-date-Palliative-Care" (an elective subject). To investigate their overall perception of death, we used the Death Attitude Inventory (DAI), developed by Hirai and others (2000), and investigated their views of death on the basis of seven factors. We also classified students on the basis of type of death they had experienced, that is, the death of a household, relative, friend, or pet. We compared the scores obtained for each factor and conducted a logistic regression analysis. <b>Results and Conclusion</b>: We analyzed the data from 120 students (valid response rate: 75.5%). Students who had experienced the death of friend, had significantly higher scores on "Life Purpose" and "Death Concern" (<i>p</i><0.05). Students who had experienced the death of household etc., statistical positive correlation with "Death Concern" and statistical negative correlation with "Death Anxiety" were recognized.

The evaluation of management of pain in elderly cancer patients receiving home-based care : the questionnaire with online system

<b>Purpose</b>: The research is aimed at the evaluation of management of pain in elderly cancer patients receiving home-based care. <b>Methods</b>: A questionnaire of 29 questions was developed and 323 home-care physicians were invited to answer the questionnaire with an online system from January 19 to 25 2011. According to answers from the general physicians, we compared the differences of answers about managements of cancer pain between two groups (>75 years old cancer patients with or without cognitive disorder) by Pearson's chi-square test. <b>Results</b>: In a the question “Are patients able to appropriately express their cancer pain?”, the ratio of physicians' answers was different;, positive answers in the patients' group with cognitive disorder was significantly lower than those without cognitive disorder (<i>p</i>=0.0043). In other questions “Do physicians feel difficulty of assessment of analgesic effect of opioids?” and “Do physicians feel difficulty of dose-selection and adjustment of opioids?”, positive answers in patients' group with cognitive disorder were more dominant than those without cognitive disorder (<i>p</i><0.0001 each). Further, in the question “Do physicians feel cancer pain management is well-done?”, positive answers were significantly lower in patients with cognitive disorder than those without cognitive disorder (<i>p</i><0.0001). <b>Conclusion</b>: With the analyses of the answers from the physicians, we found that physicians felt difficulty of both the assessment of pain and analgesic effect of opioids in patients with cognitive disorder. It should be required for the physicians to improve pain management, especially to the patients with cognitive disorder.