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Delirium occurs in 30-40% of patients with terminal cancer, and 90% of patients are delirious immediately before death. Symptoms such as agitation and hallucination are often refractory to the standard pharmacological therapy. Also, the medication options for delirium in terminally ill patients are often limited due to a difficulty in swallowing or a lack of intravenous access. We herein report a case series of six patients with terminal cancer whose derilium symptoms were treated by asenapine sublingual tablets during the intervention period by the palliative care team. Asenapine was selected when other antipsychotics were ineffective or unavailable for agitation caused by delirium. All patients suffered dyspnea or choking sensations due to dysphagia or respiratory dysfunction. Sedative effect was observed among all patients without apparent adverse events. Sublingual asenapine could be an option for the management of restlessness due to terminal delirium when both oral and intravenous drug administration routes are not available.
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The purpose of this study is to clarify the current state of nursing for the sexuality of patients with cancer at the end-of-life. In December 2018, we asked 313 nurses from 18 palliative care units in Kanagawa Prefecture about their awareness, feelings, and behavioral intentions and hands-on experience for the environment in which patients with cancer nurture love with their partners at the end-of-life. The collection rate of the questionnaire was 52.7% (165 cases). Eighty-two nurses (49.7%) had experience supporting the environment in which patients with cancer nurture love with their partners at the end-of-life. The contents of the support were “Recommend physical contact”, “Listening”, “Recommend hug”, and “Take sufficient time when entering the room, such as waiting for a reply after knocking or calling out”. Meanwhile, at ward conferences, only 11 (6.7%) had talked about the environment in which patients with cancer nurture love with their partners at the end-of-life. It has been suggested that, at present, support for the environment in which patients with cancer nurture love with their partners at the end-of-life is left to individuals and not systematically.
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Objective:To investigate the ethical challenges inhospice for community terminal cancer patients. Method:8 members of terminal Cancer Patients in palliative care wards were observed and interviewed. Datas were collected by narrative, communication,field note,work diary. Results:Get to know the ethical challenges in-hospice for community terminal cancer patients,and find the measures. Conclusions:The development of commu-nity hospice career need caring, life and death education,ethicaleducation,ethical environment improving,a harmo-nious ethical relationship and society,and life quality improving.
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<b>Purpose</b>: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. <b>Methods</b>: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. <b>Result</b>: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (<i>p</i><0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. <b>Conclusion</b>: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.
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<b>Purpose</b>; Recurrent laryngeal nerve paralysis (RLNP) is often observed in terminal cancer patients. It causes hoarseness of voice, and this interferes with a patient's communication skills. Moreover, RLNP causes aspiration, which decreases the joy of eating, and pneumonia. Although it is important to control the symptoms of RLNP in terminal cancer patients, there are few methods for their control. In this study, 3 terminal cancer patients suffering from RLNP were treated using percutaneous intrafold silicon injection. <b>Methods</b>; The injection was administered under local anesthesia through cricothyroid membrane monitoring fiberscopy. The amount of silicon to be injected was determined on the basis of fiberscopic findings; 0.4 to 2.0 ml of silicon was injected. <b>Results</b>; As a result of this treatment, a marked improvement in voice hoarseness and swallowing ability was observed in all 3 cases. No complications were observed during and after treatment. <b>Conclusion</b>; Thus, percutaneous intrafold silicon injection is a very useful and safe treatment for RLNP in terminal cancer patients.
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BACKGROUND: Untreated malignant gastrointestinal obstruction is rapidly fatal and causes various symptoms and malnutrition, and so decreases the quality of life and shortens the survival. We reviewed clinical characteristics and analyzed prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction. METHODS: We retrospectively reviewed the medical records of 63 patients with malignant gastrointestinal obstruction who had been confirmed by endoscopy or colonoscopy, upper gastrointestinal series or barium study and proper radiologic study at Sam Anyang hospital from May in 2002 to December in 2004. We excluded patients with palliative tumor resection. We analyzed prognostic factors for overall survival and symptom-free survival. RESULTS: There were 30 males (48%) and 33 females (52%), and median age of 63 patients was 64 years. The cause of malignant gastrointestinal obstruction was colorectal (26 patients, 41%), stomach (19, 30%), pancreas (4, 6%) and others (14, 23%). Twenty one patients (33%) had Eastern Cooperative Oncology Group (ECOG) performance status of 2 score and 42 patients (67%) 3 or 4 score. Forty two patients (67%) have been performed palliative procedures and 21 patients (33%) have not. Median survival of patients with palliative procedure was significantly higher than that of patients who have not been performed palliative procedures (144 days v 45 days, p=0.0001). By mutivariate analysis, palliative procedures and performance status were independent prognostic factors. However, age, gender, primary cancer, site of obstruction, and previous chemotherapy were not independent prognostic factors. Performance status was only independent prognostic factor that improves symptom free survival in patients with palliative procedures (p=0.014) and median symptom free survival was 90 days. There was no mortality on palliative procedures. CONCLUSIONS: We confirmed that palliative procedures and performance status are significant independent prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction.
Subject(s)
Female , Humans , Male , Barium , Colonoscopy , Drug Therapy , Endoscopy , Malnutrition , Medical Records , Mortality , Pancreas , Prognosis , Quality of Life , Retrospective Studies , StomachABSTRACT
PURPOSE: We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not- resuscitate (DNR) consent on the use of intravenous nutrition during the patient's last week of life and at the time of death. MATERIALS AND METHODS: The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient's last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated. RESULTS:In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient's surrogates did not have any effect on reducing the use of parenteral nutrition. CONCLUSION: The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care.
Subject(s)
Humans , Education , Hospitals, Teaching , Korea , Nutritional Support , Parenteral Nutrition , Parenteral Nutrition, Total , Terminal CareABSTRACT
BACKGROUND: In terminal cancer patients, alleviation of suffering is as important as the cure of disease. But their symptoms are often intractable. In such a case, sedation is usually considered to relieve these refractory symptoms. However, the decision to sedate has been an ethical concern to health care workers because of an effect on survival time of cancer patients. The aim of this study was to investigate the use of sedation in terminal cancer patients and its relationship with intractable symptoms. METHODS: One hundred and fifty six patients admitted to National Health Insurance Corporation Ilsan Hospital, Department of Family Medicine for hospice care from September 2000 to the end of October 2001 were enrolled in the study. Demographic data, clinical symptoms, the use of sedation, the choice of medication , reasons for administration, and frequency were recorded. RESULT: There were 81(51.9%) men and 75(48.1%) women. The mean age was 64.6+/-13.3 years. The primary sites of cancer were stomach 36(23.1%), lung 27(17.3%), and colo-rectal 19(12.2). Common symptoms were pain, nausea/vomiting, and dyspnea. Among the subjects 55(35.3%) received sedation. The drugs used for sedation were lorazepam in 37(67.3%), haloperidol in 21(38.2%), and diazepam in 18(32.7%). Sedation was administered to relieve insomnia in 20(36.4%), agitated delirium in 20(36.4%), severe pain in 9(16.4%), dyspnea in 5(8.0%), and nausea/vomiting in 1 (1.8%). CONCLUSION: Among the subjects, 55(35.3%) of 156 terminal cancer patients received sedation. Though most common symptoms were pain and dyspnea, the use of sedation was mostly limited to insomnia and delirium. Therefore, the use of sedation is not yet prevalent in Korea.
Subject(s)
Female , Humans , Male , Delirium , Delivery of Health Care , Diazepam , Dihydroergotamine , Dyspnea , Haloperidol , Hospice Care , Korea , Lorazepam , Lung , National Health Programs , Sleep Initiation and Maintenance Disorders , StomachABSTRACT
BACKGROUND: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to exfended sarvival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management. METHOD: A total 159 patients(males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors. RESULTS: The mean cost of types of medical facilities during the last week of patients as 65332.5 won in charity hospital hospice unit, 105165.5 won in home hospice, 702083.4 won in university hospital hospice unit, and 1037358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2 +/- 3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain scor of home hospice as 1.7+/-1.7 and that of university hospital hospice as 1.2+/-1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depression's categorial scale of home hospice the score was 4.8+/-1.3, which was higher than those of free hospital hospice unit and university hospital non-hospice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities. CONCLUSION: The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.