A Survey of Experience and Perception of Bereaved Families about Polypharmacy and Oral Medication of Patients with Advanced Cancer

Aims: This study aimed at investigating the status of polypharmacy and the experience and perception of bereaved family members of patients with advanced cancer regarding the burden of oral medication. Methods: Self-administered questionnaires were mailed to 303 bereaved family members of patients with advanced cancer, and 102 valid responses were analyzed (response rate, 33.7%). Results: The number of patients in the polypharmacy group (patients taking six or more tablets at a time) was 65 and that in the non-polypharmacy group (patients taking less than six tablets at a time) was 37. The percentage of bereaved family members who felt that the oral administration burden of patients was significantly higher in the polypharmacy group (43.1% vs. 10.8%, p<0.01). The results of the analysis indicated that the bereaved families wanted to reduce the number of tablets taken at a time for alleviating the burden of polypharmacy. The bereaved families of patients in the polypharmacy group were greatly concerned that the number of oral medications was too large. They also expressed the need for medical staff from whom they could seek explanation and counseling regarding the oral medication of patients. Conclusion: It is suggested that medical staff need to be fully aware of the concerns of patients’ families regarding drugs besides checking the compliance status.

Intravenous administration of vitamin B1 as an effective approach for the treatment of delirium: A case with cervical cancer at the end stage

<b>Purpose</b>: In terminally ill patients with advanced cancer,it is recognized that delirium is reversible in 20-50% of the patients with it. Identification of its cause is vital to ensure the quality of life of the patients with delirium at the end of life. We would like to report a case of the advanced cervical cancer patient with delirium, successfully treated by intravenous administration of vitamin B1. <b>Case</b>: An 83-year-old woman, who was diagnosed the advanced cervical cancer with carcinomatous peritonitis, was admitted to Shizuoka Cancer Center Palliative Care Unit. Four days after the admission, she presented sleep-wake cycle disturbance, poor attention, poor concentration,and short-term memory loss, and these conditions were diagnosed with delirium. Vitamin B1 deficiency was suspected by normal examinations including laboratory results and head computed tomography except for the low level (19ng/ml) of vitamin B1. One week after starting intravenous administration of vitamin B1, the symptoms of delirium were improved. <b>Conclusion</b>: In this case, delirium by vitamin B1 deficiency developed even though having adequate oral intake (about 1,000kcal/day), indicating malabsorption of vitamin B1 due to hypoperistalsis and edema of the bowel. Advanced cancer patients can easily develop vitamin B1 deficiency due to inadequate oral intake, increased consumption of vitamin B1 and malabsorption of vitamin B1. Therefore,the examination of vitamin B1 deficiency is necessary for patients with delirium that cannot be specified. Palliat Care Res 2009; 4(2): 330-333

BENEFITS OF A CONVENIENT, SELF-REGULATED 6-MONTH WALKING PROGRAM IN SEDENTARY, MIDDLE-AGED WOMEN / 体力科学

The purpose of this study was to determine the influence of a 6-month unsupervised, flexible and fairly light intensity walking program on endurance fitness, strength, lipids and lipoproteins and bone health in a group of middle-aged sedentary women. Six pre-menopausal and 8 post-menopausal women, aged 54 yr, served as the walk training group (W) and 9 women (2 post-menopausal), aged 49yr, served as controls (C) . W walked an average of 10, 000 steps per day for 6 months, which included an average of 5, 000 steps of brisk walking for 30 min, 4 to 5 days per week. Workloads, heart rates and double-product break point (during incremental maximal ergometer exercise), body weight and %fat, serum lipids, leg strength and bone density (by ultrasound) and induces of bone metabolism were measured at baseline and after 3 and 6 months. Walk training in W resulted in a significant improvement in maximal workload during the exercise test compared with C. Double product break point in W during exercise significantly shifted towards higher workloads and resting heart rate was reduced. Isokinetic muscular strength of leg extensors and abdominal muscular endurance measured by situps were also significantly increased in W. Estimated calcaneal bone density showed a tendency to increase after 6 months of training in W. Indicators of bone resorption and growth remained unchanged. Changes in serum lipids and lipoproteins were also favorable, but not significant. In conclusion, these results show that a flexible and self-regulated walking program is sufficient to elicit improvements in cardiovascular endurance, aerobic capacity measured by DPBP and strength of leg and abdominal muscles. Bone strength and serum lipids were not clearly improved after 6 months with this walking program. If training time were extended to 12 months, significant improvements in these measures can be expected because tendencies toward improvements were observed.