Integrated Distress Activity Score (IDAS): A Possible Tool for Determining Continuous Deep Sedation

Integrated Distress Activity Score (IDAS) was developed in order to evaluate both positive and negative aspects of patient’s conditions throughout hospitalization. IDAS were evaluated by nurses everyday and when patients continued to have IDAS less than or equal to zero, we used this tool for determining continuous deep sedation. From 2013-2017, 1306 patients were enrolled in the study. The average rate of continuous deep sedation in the PCU was 1.2%(16 patients). Dyspnea was the most common condition (62.5%, 10 patients), followed by delirium (37.5%, 6 patients).The average days that took to decide for sedation (from the day when IDAS was less than or equal to zero), was 3.7 days. This study suggested that IDAS could be a useful tool for determining continuous deep sedation.

Outpatient Department for Early Palliative Care: Retrospective Study

<p>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.</p>

Disclosure of Survival Prediction Prior to Referral to the Palliative Care Department: Retrospective Study

<p>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.</p>

Marked lactate dehydrogenase elevation and tachypnea due to lactic acidosis in a patient with terminal stage prostate cancer: the first report 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.

The Training Program That Integrated Palliative Care with Oncology

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.

Successful pain control in a patient with a desmoid tumor complicated by having selected the medicine considering the pharmacokinetic of the opioid

<b>Case</b>: 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. <b>Discussion</b>: 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.

Study on the efficacy of and adverse reactions to high-dose dexamethasone therapy for neurological symptoms of spinal cord compression due to malignant tumors

<b>Objective</b>: 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. <b>Subjects</b>: 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. <b>Results</b>: 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. <b>Discussion</b>: 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.

The cancer caring salon at night: compared with daytime

<b>Background</b>: Most of cancer caring salons (a following salon) are held at the daytime, and there is no report that we weighed against a salon at night. <b>Purpose</b>: We weigh the participation number of people, the differences of participation reason by the time of salon and examine the problems of the salon at the daytime. <b>Method</b>: From July, 2012 to December, we held salons for two hours. The salon at the daytime started at 14:00, and the salon at night was at 18:00. We distributed the questionnaire to participants and examined them. <b>Results</b>: 69 people participated. 22 people (32%) participated at the daytime, and 47 people were at night (<i>p</i>=0.004). Questionnaires are collected in 55 people; a response rate is 80%. Participants less than 60 years old were eight (40%) at the daytime, and 21 (60%) at night. The most common reason of choice the participant time was "not in particular (55%)" at the daytime, and "circumstances of the work (34%)" at night. <b>Conclusion</b>: Young working generations tend to be hard to participate in the salon at the daytime, and the salon at night may be useful.

Alternative routes of administration in palliative medicine: availability of sublingual administration

<b>Purpose</b>: Evaluation of the efficacy and safety of sublingual drug administration in palliative care patients lacking the ability to swallow as well as other drug administration routes. <b>Methods</b>: Buprenorphine, 0.1∼0.2mg/dose (n=15) and fentanyl, 0.05∼0.2mg/dose (n=26) were administered sublingually for cancer pain, and midazolam, 0.1mg/kg (n=16) for insomnia respectively. <b>Results</b>: The three drugs were all rapidly absorbed by the oral cavity and showed efficacy in about 90% of patients. No adverse events were observed other than drowsiness, nausea and over production of sputum in patients suffering from dysphagia. <b>Conclusion</b>: Sublingual administration is a viable alternative for maintaining the quality of life of patients not accessible through conventional administration routes in the palliative setting. Palliat Care Res 2010; 5(1): 201-205