The Effect of Fan Therapy for Dyspnea in Patients with Chronic Progressive Disease: Systematic Review and Meta-analysis

Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.

Opioids for Secondary Generalized Hyperhidrosis Associated with Renal Cell Carcinoma

We encountered a case where opioids were effective for excessive sweating caused by secondary generalized hyperhidrosis associated with cancer. ​​A 64-year-old woman diagnosed with metastatic renal cell carcinoma was admitted to the palliative care unit with right hip pain caused by bone metastasis and sudden excessive sweating. An increased dose of fentanyl transdermal patch provided pain relief. Excessive sweating seemed to have occurred due to neoplastic fever initially, but antipyretic analgesics and steroids were ineffective. Prophylactic use of immediate-release oxycodone provided excessive sweating relief. Finally, we consider that hypothalamus and fentanyl transdermal patch were involved in excessive sweating. Opioids may suppress sweating by acting on the hypothalamus.

Survey on Timing Related to Preparation and Publishing of Risk Management Plans / 医薬品情報学

Objective: Risk Management Plan (RMP) is created and submitted by a pharmaceutical company while applying for new drug approval; it is published to be used by healthcare professionals. For example, healthcare professionals utilize RMP when considering whether to adopt a drug. However, there is no stipulation for the release date of RMPs; moreover, surveys regarding this are limited. We conducted a cross-sectional survey on the relationship between RMP-related timing and regulatory affairs-related timing.Methods: The surveyed drugs were those for which the first version of RMP was notified by PMDA Medinavi (mail delivery service) in FY2014 and FY2018. We examined regulatory affairs-related timing (i.e., “manufacturing and marketing approval date,” “drugprice standards listing date,” and “release date”) and RMP-related timing (i.e., “RMP creation date” and “Medinavi delivery date”).Results: For 7 of 43 items in FY2014 and 5 of 41 items in FY2018, the “RMP creation date” occurred later than the “drug-price standards listing date.” For one item in FY2014, the “RMP creation date” occurred later than the “release date.” For 12 items in FY2014 and 13 items in FY2018, the “Medinavi delivery date” occurred later than the “release date.”Conclusion: No considerable difference was confirmed between FY2014 and FY2018 regarding RMP-related timing and regulatory affairs timing. It was confirmed that there were several items for which the RMP creation occurred later than drug-price standard listing and items for which the publishing notice by Medinavi was delayed for drug marketing release. To promote the utilization of RMPs by healthcare professionals, RMPs must be created and published without delay.

The Support in Opioid Introduction Period for Outpatients with Cancer by Palliative Care Staffs

Introduction: Our palliative care staff began the support activity in opioid introduction for outpatients with cancer at Komaki City Hospital in March 2018, because it was difficult to make them understand about proper use of opioid analgesics and misinterpretation about abuse at the time of opioid introduction in outpatient settings. This study aimed to evaluate the effects of the activity (patient education on pain control, telephone follow up, and assessment of the symptom). Method: Outpatients with cancer receiving strong opioids for pain relief from January 2017 to March 2019 were eligible. We retrospectively investigated the difference of the variables between baseline and after the activity as follows; the ratios of prescribing immediate-release opioids, antiemetics, and laxatives when opioids were prescribed and side effects due to opioid analgesics appeared. Results: The study included 122 patients. The prescribing ratios of immediate-release opioids antiemetics and laxatives all increased from 90.7 to 98.5%, from 63.0 to 70.6%, and from 61.1 to 70.6%, respectively. The side effect incidence due to opioids with STAS-J 2 or more decreased from 12 (22.2%) to 9 (13.2%). Discussion: The activity could contribute to the provision of drug treatments and counselling needed for opioid therapy.

Multi-Institutional Joint Study on Adverse Events of Original and Generic Gemcitabine Drugs (Gemzar® vs. Gemcitabine Sandoz) Using Propensity Score Matching / 医薬品情報学

Objective: The use of generic drugs is promoted to reduce medical costs and copayments. However, tumor agents are expensive and generic drugs are not widelyused. Thus, it is necessaryto evaluate the safetyof generic drugs in more detail. We compared the incidence of adverse events between the original drug (Gemzar®: GEM) and generic drug (Gemcitabine [Sandoz]: GE-GEM) using propensityscore (PS) matching.Methods: We investigated adverse events in patients who received one course of GEM or GE-GEM. The patient background (age,sex, BSA, cancer type, stage, metastasis, surgical history, and radiotherapy) and administration status (administration route and RDI) were used to calculate the PS.Results: Among all patients (GEM: 51, GE-GEM: 54), a significantlygreater number in the GE-GEM group had cancer metastasis. On comparison of adverse events, there were significantlymore cases of vascular pain (p＜0.05) in the GEM group, and manycases of nausea (p＝0.08) and rash (p＝0.08). Fortypatients in each group were extracted byPS matching. There were no significant differences in the patient background between the groups, and on comparison of adverse events, the two groups did not significantly differ.Conclusion: Our studysuggested that there is no difference in side effects between Gemzar® and gemcitabine [Sandoz]. To compare the incidence of adverse events, it is useful to use PS matching in clinical practice.

Administration of Corticosteroids Is Effective for Hyperactive Delirium Due to Intravascular Large B-cell Lymphoma: A Case Report

Introduction: Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma. Patients with IVLBCL frequently have neurological symptoms associated with cerebrovascular infarction or central nervous system involvement of malignant lymphoma. Case: A 67-year-old man consulted the Department of Hematology at our hospital because of fever of unknown origin, anemia and increased serum lactate dehydrogenase. Although IVLBCL was strongly suspected, no lymphoma cells were found by multiple bone marrow aspirations and skin biopsies. Two months later, he developed hyperactive delirium, which was difficult to manage using antipsychotic agents. Brain MRI revealed multiple hyper-intense infarct-like lesions on diffusion-weighted images. After assessment of bone marrow aspiration and skin biopsies, he was administered an enough dose of prednisolone to manage malignant lymphoma. Hyperactive delirium rapidly improved. Discussion: In patients with IVLBCL, corticosteroids may be useful to manage hyperactive delirium due to cerebrovascular infarction or central nervous system involvement of IVLBCL.

Efficacy and Safety of Subcutaneous Levetiracetam Injection for Terminally-ill Cancer Patients: A Case Report

Introduction: Antiepileptic drugs were occasionally administered to manage seizures in terminally-ill cancer patients. When enteral route is no longer feasible due to dysphagia or depressed level of consciousness, subcutaneous route could be an option. We reported three cases of terminally cancer patients who received subcutaneous levetiracetam (LEV) due to an inability to administer via intravenous route. Cases: The age of 3 cases was 83, 75, 82 years, respectively. In all cases, the prognosis prediction at the start of subcutaneous LEV was about 1 month. In all cases, the route of administration of LEV was changed from intravenous to subcutaneous. No exacerbation of convulsions, or injection site reaction was confirmed after subcutaneous LEV administration. Discussion: We believe that subcutaneous LEV administration may be one of the treatment options for seizures in patients with terminal cancer for whom intravenous administration of LEV is no longer feasible.

Survey of the Description of “Medication Guides for Patients” and “Early Post-Marketing Phase Vigilance” on Additional Risk Minimization Activities of Risk Management Plans / 医薬品情報学

Objective: The risk management plan (RMP) is a useful information source for healthcare professionals, including pharmacists, to ensure drug safety. The “risk minimization activities” (RMA) of the RMP are especially important elements for healthcare professionals. It is known that “Medication Guides for Patients” (MGP) and “Early post-marketing phase vigilance” (EPPV) are items listed as part of the RMA. However, the creation of MGPs and the implementation of EPPVs are not performed for all medicines. In a previous study, it was difficult to evaluate this sufficiently with the safety specifications. The aim of this investigation was to evaluate RMAs, especially MGPs and EPPVs, not in terms of the safety specifications of RMP.Methods: The previously published RMPs of 177 drugs were obtained on February 22,2016, and used in the analysis. The relationship between the creation of the MGP and the description in the RMA and the relationship between the conduct described in the EPPV and the description in RMA was investigated for each medicine.Results: An MGP was created in 151 of the analyzed drugs. Of these, it was not listed in the RMA of 40 drugs. In contrast, EPPV was not listed in RMA in 2 out of 33 drugs when underway. EPPV was described in the RMA of 33 of the EPPV finished drugs. The time lag from the end of EPPV until the revision of the RMP was 4.5 month son average.Conclusion: MGPs and EPPVs are created especially for drugs requiring patient education, information provision, or safety monitoring. Therefore, for drugs for which MGPs or EPPVs are required, they should be listed in the RMA. In this study, the time lag of RMP revision was also highlighted as a problem. In order to promote the utilization of RMP by pharmacists, these issues should be resolved.

Adverse Effects of Oxygen Therapy for Dyspnea in Terminally Ill Cancer Patients: A Retrospective Single Center Analysis

Context: In addition to opioids, oxygen therapy is often administered to cancer patients suffering from dyspnea before death, but there are few reports of adverse effects of this treatment. Objectives: To clarify the frequency of adverse effects of oxygen therapy for hospitalized cancer patients before death. Methods: A retrospective study of all patients who died and were discharged from the palliative care unit in Komaki City Hospital from January 2016 to June 2018 was performed. Patients to whom oxygen therapy had already been administered at the time of admission were excluded in the study. Results: The study included 257 patients, with 195 (76%) in the oxygen therapy group (O2+). The cumulative rate of oxygen therapy was 36% seven days before death, 54% three days before death, and 76% a day before death. The adverse effects included a sense of restraint for 64 cases (31%), exacerbation of delirium for 27 cases (14%), nasal/oral hemorrhage for 25 cases (13%), dryness for 5 cases (3%), and deterioration of subjective symptoms for 4 cases (2%). Along with these effects, temporary interruption of oxygen therapy was observed in 76 cases (39%). Conclusion: Oxygen therapy was started in half of the cases within 3 days before death. The adverse events to occur frequently were feeling of restriction and exacerbation of delirium.

Survey of Direct-Acting Oral Anticoagulants for Non-Valvular Atrial Fibrillation / 日本農村医学会雑誌

Direct-acting oral anticoagulants (DOAC) were approved for the prevention of cardiogenic embolism in non-valvular atrial fibrillation in recent years. However, the dosage of DOAC has to be reduced in patients with bleeding tendencies where the risk of hemorrhage is high, and dose reduction strategies differ depending on the type of DOAC. Therefore, we examined the dosage regimens of 4 DOACs (dabigatran, rivaroxaban, apixaban, edoxaban). Among 129 patients treated with DOACs, 85 received the standard dosage and 44 received non-standard dosage regimens. Among the non-standard dosage patients, 6 were taking a high dose (dose reduction was desirable) and 38 patients were taking a low dose (low dose is usually desirable). The low dosage group were significantly older and had a significantly lower CHADS2 score than that of the high dosage group. Hemorrhagic events occurred in 2 patients in the standard dosage group and in 3 patients in the low dosage group. Also, a thrombotic event occurred in only 1 patient in the standard dosage group. About 30% of the patients were on low dosage versus standard dosage. In practice, attending physicians tend to reduce the dose to avoid a hemorrhagic event particularly in elderly persons. However, a hemorrhagic event also occurred with low dosage in this survey. The validity and safety of dosages outside the limits of standard dosage have not been reported even though this dosage method is commonly used in clinical practice. Thus, more data should be accumulated from a large-scale cohort study to clarify this.

A Case of Emphysematous Cystitis with Lung Cancer at the End Stage

Introduction: We report on a patient with end-stage lung cancer who developed the relatively rare condition of emphysematous cystitis. Case: A 72-year-old man was diagnosed with carcinomatous meningitis while being treated for lung cancer and bone metastasis. Anticancer therapy was terminated, and he was transferred to our palliative care unit. During the transfer, he exhibited progressively impaired consciousness and bilateral leg paralysis. Imaging studies performed to assess his medical state revealed intrathecal nodes associated with carcinomatous meningitis and emphysema in the bladder wall. Emphysematous cystitis was diagnosed. The bladder was irrigated and drained, and antibiotic therapy was administered. Although the bladder wall emphysema resolved, the patient died of progression of carcinomatous meningitis on the 10th day after transfer. Discussion: The development of emphysematous cystitis is reported to be likely in patients with underlying diseases, such as malignant tumor, diabetes mellitus, and neurogenic bladder, as well as in those with a history of steroid use. Our patient also exhibited many risk factors, including a history of steroid use and bladder and rectal disturbance due to carcinomatous meningitis, in addition to cancer. In end-stage cancer patients, the risk of developing emphysematous cystitis is expected to be higher than in normal persons because they have often used steroids for malaise, anorexia, and other conditions, and exhibit metastasis to the central nervous system, drug-induced dysuria, and other complications. Caution should be exercised in end-stage cancer patients to recognize emphysematous cystitis, which can be life-threatening in some cases.

A Retrospective Observational Study to Explore Trajectories of Hematologic Data and Palliative Performance Scale Scores in the Last 12 Weeks among Patients with Terminal-stage Cancer

Objective: To explore the trajectories of hematologic data and palliative performance scale (PPS) scores among patients with terminal-stage cancer. Method: This was a retrospective observational study. We recruited all adult patients with solid cancer who received care from palliative care specialists and died in Komaki City Hospital between January and December 2016. Among these patients, we extracted hematologic data from the last 12 weeks and when 2 weeks passed since the last anti-cancer treatment, and PPS scores on the day of the hematologic tests. We calculated the means of weekly hematologic data and PPS scores, and explored their trajectories. Results: We recruited 204 patients (mean age, 70.9 years; women, 44.1%) and acquired 1157 hematological datasets. Albumin and C-reactive protein levels gradually decreased from 12 weeks and increased from 5 weeks, respectively, before death. White blood cell and lymphocyte counts respectively increased and decreased from 5 weeks. Creatinine and bilirubin levels rapidly increased from 3 weeks. Potassium levels increased from 1 week. PPS scores decreased from 4 weeks before death. Discussion: Deteriorations in nutrition or inflammatory status and white blood cell counts could antedate deterioration in PPS scores, and deterioration of visceral data and PPS scores could indicate prognosis on a weekly basis.

Relationship between Meropenem Use and Resistance Rate of Pseudomonas Aeruginosa / 日本農村医学会雑誌

　　The World Health Organization (WHO) recommends antimicrobial use density (AUD) as an indicator for evaluating the amount of antimicrobials used, an index that is now widely employed in many facilities. Defined daily doses (DDD) set by WHO are used for calculating AUD. However, discrepancies have been noted between other countries and Japan in the standard dosage of antimicrobials, which may cause a problem evaluating antimicrobial use with the DDD. Therefore, in this study, we calculated AUD (modified antimicrobial use density: mAUD) with the DDD (modified defined daily dose: mDDD) of our hospital for the carbapenem antimicrobial meropenem (MEPM), mAUD, and resistance rate of Pseudomonas aeruginosa. From 2010 through fiscal year 2016 (ending in March), AUD was 5.9±1.4, 7.0±2.9, 8.2±2.3, 6.8±2.1, 7.3±2.2, 7.0±2.1, and 8.0±3.0 and mAUD was 11.7±2.7, 12.0±4.9, 11.3±3.1, 11.0± 3.4, 11.4±3.5, 11.5±3.5, and 11.2±4.2, respectively. The corresponding resistance rate of P. aeruginosa was 35.1%, 37.9%, 10.0%, 6.0%, 22.6%, 10.6%, and 10.0%. A significant positive correlation was found between mAUD and the resistance rate of Pseudomonas aeruginosa (P < 0.01, r = 0.88). Our results confirm that the mAUD is an effective index for controlling resistance of P. aeruginosa.

A Case with Pneumatosis Cystoides Intestinalis with Intra-abdominal Free Air following Steroid Therapy for End-stage Brain Tumor

<p>Introduction: We experienced a case of pneumatosis cystoides intestinalis with intra-abdominal free air following steroid therapy for an end-stage brain tumor. Case: The patient was a 67-year-old man. He had received surgery and chemotherapy for the brain tumor, but the disease progressed and his consciousness deteriorated. Eventually, he developed aspiration pneumonia and was hospitalized. His consciousness level remained poor even after the pneumonia improved. His survival prognosis was considered to be approximately 1 month, and he was transferred to a palliative care ward. After the transfer, administration of betamethasone 8 mg/day was started for the purpose of improving his level of consciousness. Temporary improvement was observed, and administration of this drug was continued with dose adjustments, as appropriate. Six weeks after the start of betamethasone administration, when his consciousness level again deteriorated, aspiration began to recur. Chest X-rays, obtained to assess pneumonia, showed intra-abdominal free air. Pneumatosis cystoides intestinalis was confirmed by computed tomography. He had few abdominal symptoms, and was managed conservatively. He died of respiratory failure. Conclusion: Pneumatosis cystoides intestinalis is mostly secondary, and steroid therapy is considered to be one of the causes. But follow-up observation is often conservative, and judgment of discontinuation of steroid needs to be made in consideration of its effect and prognosis is there.</p>

Assessments of Therapeutic Equivalence and Pharmacoeconomics of Original-Brand and Generic Drug of Glimepiride (Amaryl® vs. Glimepiride [Tanabe]) / 医薬品情報学

<b>Objective: </b>The use of generic drugs is promoted for the purpose of reductions of medical costs and patient’s copayment.  In general, it is thought that clinical effects of the original brand and the generic drugs are equal if they are bioequivalent.  However, it is necessary to inspect their therapeutic equivalence to use the generic drugs securely.  We, therefore, assessed the therapeutic equivalence and pharmacoeconomics by substitution of an original drug (Amaryl®) with a generic drug (Glimepiride [Tanabe]).<br><b>Methods: </b>Therapeutic Equivalence: The total variation was calculated by using the HbA1c levels before it switched from Amaryl® to Glimepiride [Tanabe].  The tolerance limits were set as 1/4 of the total variation.  Pharmacoeconomics: The difference of drug prices and the difference of patient’s copayment were calculated.<br><b>Results: </b>As the variation of HbA1c levels was within tolerance limits before and after switching from Amaryl® to Glimepiride [Tanabe], we evaluated that their therapeutic effect was equivalent.  The difference of drug prices after switching from the original to the generic one was 4,582.6 yen/year on average (minimum: 949.0 yen, maximum: 12,045.0 yen); the difference of patient’s copayment was 872.5 yen/year on average (minimum: 0 yen, maximum: 3,613.5 yen).  These data show that the use of the generic drugs is effective to reduce medical costs.<br><b>Conclusion: </b>For further promoting the use of the generic drugs, we consider it essential to compare the therapeutic equivalence and the safety of the original and the generic drugs in clinical practice.

Study of TTR in Patients Receiving Warfarin Therapy / 日本農村医学会雑誌

　　We worked out TTR values in patients receiving warfarin treatment in Abashiri-Kosei General Hospital. The patients were divided into two groups - those with satisfactory TTR values and those with poor TTR values - and associations between patient factors and average dosing interval were examined in the two groups. A total of 178 patients joined this study. The average TTR value worked out at 65.1±24.8%. It was found that the average TTR value for those patients aged at 70 and above came to 72.7±21.4%, which was significantly high as compared with 51.06plusmn;24.6% for those under 70 years of age. When the average TTR value was calculated after the optimal PT-range for the group of those below the age of 70 was changed from 2.0～3.0 to 1.6～2.6, it rose from 51.0% to 74.9%. These findings made it clear that PT-INR, regardless of age, was under control within the range from 1.6 to 2.6 in this hospital in accordance with the results of the J-RHYTHM Registry analysis.

Decision-making support for cancer patients and their families at a palliative care clinic in a designated regional cancer care hospital

<b>Objective：</b>There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services.<b> Method：</b>We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. <b>Results：</b>The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. <b>Conclusion：</b>The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.

The report on the case of pregabalin has been successful for chronic cough associated with metastatic lung tumor

<b>Purpose：</b>Chronic cough is one of the symptoms that lead to a reduction in the quality of life insomnia, such as the decline in physical strength. For chronic cough due to metastatic lung tumors, and we experienced an example of after use pregabalin, showed a reduction of symptoms. <b>Case：</b>This case is a 75-year-old man. Abdominoperineal rectal amputation was performed in rectal cancer. Adjuvant chemotherapy has been performed, but multiple lung metastases appeared one year after surgery. Chemotherapy was continued, but lung metastases progressed, it became the policy of anti-cancer treatment ended 4 months after 2 years after surgery. Cough worsened since then, it was referred introduced to palliative care department. Because we thought respiratory tract irritation increased by organic disease is the cause, it starts from 50 mg／day pregabalin, it was increased by 25～50 mg while aware of potential side effects, such as drowsiness during the day. Cough relief at 125 mg／day, night sleep wasalso secure and possible. <b>Conclusion：</b>Pregabalin which is effective in neuropathic pain, there is a possibility that the suppression of hyperexcitability of nerve cells that are its pharmacological action, is also effective in chronic cough, it becomes choice of antitussive different mechanisms of action and opioid there is a possibility that may.

Appearance of Side Effects Related to Non-ionic Iodine Contrast Medium / 医薬品情報学

<b>Objective: </b>We investigated the incidence of side effects related to contrast medium employed in our hospital based on monitoring materials to improve the safety of contrast-enhanced examinations.  Furthermore, we compared the incidence of side effects between the original product and generic drugs to confirm the safety of each preparation.<br><b>Methods: </b>The survey period was from April 2007 until March 2011.  Based on the number of patients who underwent contrast-enhanced examinations and that of patients with side effects, we calculated the incidence of side effects in our hospital, and confirmed its annual changes.  Subsequently, we again collected the incidence of side effects per each manufacturer’s preparation employed, and confirmed the state of side effects of individual preparations.  Furthermore, we evaluated the symptoms as side effects, interval until appearance, and treatment for side effects during the data collection period, as well as the subsequent state, symptoms as side effects, and interval until appearance.  The chi square independence test was employed to compare the results among groups.  <i>p</i><0.05 was regarded as significant (paired test).<br><b>Results: </b>There were no changes in the annual incidence of side effects.  There were also no significant differences in the annual incidence of side effects among the preparations.  Furthermore, there were no marked differences in the symptoms, interval until appearance, treatment for side effects, or subsequent state among the preparations.<br><b>Conclusion: </b>We investigated the appearance of side effects regarding contrast-enhanced examinations for 4 years.  We confirmed that there were no differences in the incidence of side effects among the preparations.

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