ABSTRACT
In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia（PCA）pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku（Easy）Pack”that are characterized by the following：（1）opioids are prescribed by a home care physician；（2）a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution；（3）the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital；and（4）the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.
ABSTRACT
<b>Purpose & Methods</b>: With the aim of investigating how early palliative care intervention should be provided, we conducted questionnaire-based screening and QOL evaluations of patients undergoing first-line chemotherapy before and at 3 to 4 weeks after the initiation of treatment, using "a questionnaire on the ease of daily living" and the EuroQol (EQ5D), respectively. <b>Results</b>: Of the 66 patients who participated in this investigation, 56 completed the second survey. With respect to "Concerns and Worries", more than half of the respondents complained concernes/worries about "Conditions and/or Treatments" both before and after chemotherapy, but there were changes in content between the first and second surveys. "Physical Symptoms" were experienced by more than 80 percent of patients before treatment. After treatment, 13 patients saw improvement or disappearance of their symptoms and 22 patients experienced new symptoms. "Emotional Distress" decreased after treatment. This decrease was more pronounced among patients who expressed concerns about their conditions and/or treatments in the first survey. EQ5D health utility scores tended to decrease in patients who had presented with adverse reactions, but improved in those free of adverse reactions. <b>Conclution</b>: Changes were observed in patients' palliative care needs before and after the initiation of first-line chemotherapy, which indicates a need for sequential screening over the course of treatment.