Research progress on the application of life review therapy in patients with advanced cancer / 中国实用护理杂志

It introduced the concept and meaning of life review therapy and the requirements of the implementer and the time choice in the implementing scheme. This study aimed to provide the reference for improving the life quality of terminally ill cancer patients.

Evaluation of the Successful Insertion Rate of PICC among the Puncture Sites at the Cubital Fossa for Terminally-ill Cancer Patients at the Bedside

<p>Aims: This study aimed to compare the difference in successful insertion rates of peripherally inserted central venous catheters (PICCs) between the different insertion sites at the cubital fossa (basilic, medial cubital and cephalic vein) for terminally-ill cancer patients at the bedside. Methods: Data from eighty-eight terminally-ill cancer inpatients who underwent insertion of PICC from September 2011 to April 2014 were retrospectively analyzed. Successful PICC insertion was defined when the catheter tips were placed in the superior vena cava. Results: PICC insertion was successfully carried out in 72/88 patients (81.8%) in total; 43/50 patients (86.0%) via basilic vein, 23/31 patients (74.2%) via medial cubital vein, and 6/7 patients (85.7%) via cephalic vein. There was no significant statistical difference between the three different approaches in the success rate of PICC insertion (P=0.39). Conclusion: Our findings suggest that the cephalic vein serves as an alternative puncture site of PICC insertion at the cubital fossa for terminally-ill cancer patients under unavoidable clinical circumstances.</p>

Physicians’ and Nurses’ Attitudes toward Infectious Diseases in Terminally-ill Cancer Patients: What Determines Their Variabilities?

<p>Clinical decisions on infectious diseases in terminally-ill cancer patients are often made based on physicians’ and nurses’ personal medical experiences, which may lead to an intra-team conflict. We conducted a qualitative analysis with prospectively gathered, semi-structured interviews in order to identify physicians’ and nurses’ beliefs and perceptions contributing to the variabilities in their attitudes toward patient care and the conflicts during decision-making process. We obtained the following categories with respect to beliefs and perceptions: estimated prognosis; patient’s discomfort due to tests and treatment; agreement to physician’s treatment plan; patient’s and family’s wish for tests and treatment; and patient’s benefits by tests and treatment. The intra-team conflicts resulted from disagreement on patient’s condition, and difficulty understanding mutual intent or opinion among physicians and nurses. Our findings may help improve team-based communication and the quality of care in terminally-ill cancer patients with infectious diseases.</p>

Halo-vest for cervical pain in a home care patient with esophageal cancer and cervical spine metastases

Introduction：Halo-vest is usually used temporary to immobilize the cervical spine after surgery or injury. We experienced a good pain relief by halo-vest attachment in one patient with metastatic tumors of cervical spine. Case：A 76-year-old male patient was diagnosed with cervical spine metastases during chemotherapy treatment for lymph node recurrence 7 years after the first surgery for his esophageal cancer. His neck and back pain did not improve even after pain management by analgesics and radiotherapy. He also experienced strong side effects due to opioid treatment. Eventually, he became immobile. Halo-vest was applied solely for the purpose of pain control. Since then, his pain diminished, opioid stopped and his gait recovered. After moving to a hospital close to his home, he was discharged from the hospital. He could stay at home without a severe complication and opioids for 2 months. Discussion：Fixation of the cervical spine with halo-vest might be a good procedure for pain relief in patients with cervical spine metastases. However, since it could also be a stressful treatment and might cause a severe complication, thorough discussion for the use of a halo-vest is mandatory with the patient, family, and orthopedists.

Effect of fan for dyspnea in terminally ill cancer patients：Case series study

The effects of a fan to reduce dyspnea have been evaluated in several trials worldwide, however, there has been no clinical report in terminal cancer patients in Japan. We conducted a retrospective chart review to examine whether a fan is useful for dyspnea in terminally ill cancer patients. We reviewed medical and nursing records and selected all patients（<i>n</i>＝9）who received a fan from July 2013 and January 2014. The primary outcome measure was a decrease dyspnea measured by a visual analogue scale（VAS；0＝no shortness of breath, 100＝worst shortness of breath）. There was a significant difference in the VAS score after treatment with the fan（40.2±11.8 versus 15.6±14.9, <i>P</i>＝0.004）. Our results suggest that a fan may help in reduces the sensation of dyspnea in patients with terminal cancer. Future prospective study is needed.

Survey on oral care of terminally ill cancer patients in our hospital

<b>Purpose:</b> Patients with end－stage cancer are prone to various problems in their oral mouth. Survey of nurses’ attitudes regarding oral care in our cancer base hospital was conducted and discussed. <b>Method:</b> 197 nurses working with terminally ill cancer patients in the hospital were involved in the questionnaire survey. <b>Results:</b> 159 nurses completed the questionnaire (81%). 153 nurses responded that oral care was necessary for end－of－life stage (96%) but only 29 nurses responded that adequate oral care was provided (18%). <b>Conclusion:</b> The results showed that the nurses acknowledged of importance of oral care at end－of－life stage but didn’t provide the adequate oral care. The survey found that requesting oral care and relief of symptoms as supportive care are lacking of cooperation with the Dentists. How to share information and work with out－of－hospital dentists will be a challenge in the future.

Personal growth and related factors among family primary caregivers after bereavement of a terminally ill cancer patient at home

<b>Purpose:</b> To identify the nature of personal growth of family primary caregivers after bereavement and to explore the association between such growth and the experience of caring for a terminally ill cancer patient at home. <b>Methods:</b> A self-administered questionnaire survey was mailed to 112 bereaved family primary caregivers who, with assistance from a palliative care service, had cared for a terminally ill cancer patient at home. The main outcomes were measured using the After Bereavement Growth Inventory, previously developed. <b>Results:</b> Responses from 73 questionnaires were analyzed (effective response rate, 66%). The post-bereavement growth score was significantly higher among the study group than among the general population who had experienced bereavement due to illness-related death. Multiple regression analysis revealed that post-bereavement growth was more likely to occur among those family members who, "at the time they chose to provide home palliative care, intended to care for a patient at home until the time of death" and when "the patient desired home palliative care", those who "felt a deepening of their bond with the patient", and those who "felt the death was peaceful". <b>Conclusion:</b> Our findings suggest that for primary family caregiver's to experience personal growth after bereavement, medical professionals should support patients' preference of place at the end of life and caregivers' preparation for the expected home death, respect the family's bond with the patient, and through appropriate symptom management in home palliative care to maintain the patient's sense of peacefulness until the end of life.

Support for leaving the palliative care unit temporarily in end-stage terminally ill cancer patients

<b>Purpose</b>: We evaluated the significance of support for leaving the palliative care unit temporarily in end-stage terminally ill cancer patients. <b>Methods</b>: We retrospectively investigated the medical records of 27 terminally ill cancer patients who died within 15 days after leaving our palliative care unit temporarily, between January 2011 and December 2012, and distributed a questionnaire to their bereaved family. <b>Results</b>: The age of the patients ranged from 29 to 91 years. Ten patients left the unit without stay and 17 left overnight. The destination of 24 patients was their home, while three had other destinations. For 11 patients, the main purpose of leaving the unit was to finish business, and for 9, was to see their houses once again. After returning to the hospital, the comments of 15 patients were affirmative, and those of 6 were negative. Questionnaire responses were obtained from 18 persons. Families reported anxiety regarding and difficulty with adaptation to the sudden change when the patients left the unit, apparatus support, patient transfer, and patient care. <b>Conclusions</b>: It was useful for the terminally ill cancer patients and their families to receive support when leaving the palliative care unit temporarily. Strategies to cope with the sudden change at the time of leaving the unit could help families feel reassured and secure.

Effectiveness and long term safety of gabapentin in the management of neuropathic pain of terminally-ill cancer patients

<b>Purpose</b>: This study is aimed at the evaluation of the effectiveness and safety of gabapentin for the management of cancer-related neuropathic pain in terminally-ill cancer patients. <b>Methods</b>: We investigated terminally-ill cancer patients prescribed gabapentin for the management of cancer-related neuropathic pain, from November 200X to October 200X+2. We assessed average daily pain on the numerical rating scale (NRS) before administration, after one week, and while on a stable dose. <b>Result</b>: 44 patients were enrolled during this period and 19 patients completed the study. The medication and the survival period on average were 52.0 and 67.2 days, respectively. The average gabapentin daily dose after one week was 358 mg. The average period needed to reach a stable dose was 11.6 days and the average stable daily dose was 463 mg (male 620 mg, female 289 mg). The mean NRS decreased from 5.7 (before) to 2.1 (after one week, <I>p</I><0.001) and 1.9 (stable dose, <I>p</I><0.001), respectively. 57.9% of patients showed side effects, somnolence in 52.6%, delirium in 5.3%, tremor in 5.3%. <b>Conclusion</b>: Gabapentin can be expected to be effective and safe for managing cancer-related neuropathic pain for a long period even when in critical condition through careful titration. Palliat Care Res 2011; 6(1): 101-108

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

Clinical considerations about terminally ill cancer patients who died in hospice unit / 대한내과학회지

BACKGROUND: Although physicians state that patients ideally should receive hospice palliative care for 3 months before death, the majority of patients survive less than one month in hospice palliative care. This is too short to do effective hospice palliative care. Therefore, we figured out the problems through the clinical considerations about terminally ill cancer patients who had died in hospice unit. METHODS: From July to December in 2003, 107 patients with terminally ill cancer who had died in Sam Anyang Hospice Unit were enrolled in this study. For getting the informations about patients characteristics, we reviewed the medical records and interviewed the patients on the first visit. RESULTS: There were 70 males (65%) and 37 females (35%), and median age of patients was 60 years (range 23-93). The most common cancer was stomach cancer (18 patients, 17%). Forty seven patients (44%) took analgesics, the others 60 (56%) not. The most common symptom was pain (75 patients, 70%) and the most prevalent reason for admission was also pain (60, 56%). The most prevalent physician specialty who transferred patients or referred to local hospital was other internal medicine (48 patients, 44%), followed by hemato-oncology (38, 36%), surgery (12, 11%) and others (9, 9%). The median duration between the day when the patients were diagnosed as terminally ill cancer patient and the day when they were referred to hospice center is 48 days. The median survival in hospice palliative care is 30 days. The median hospitalization is 19 days. CONCLUSION: We found that lack of recognition about hospice palliative care of physicians, patients and families made the length of hospice palliative care too short. To do effective hospice palliative care, it needs education and promotion for them constantly.

The Present Status and Problems in Terminal Cancer Care

Cancer is the most common cause of death in Korea. Therefore, the care of terminally ill cancer patients represents a major issue of Korean welfare. Because of lack of hospice and palliative care education and government support, most terminally ill cancer patients are not given proper care with due human dignity. The hospice and palliative care education include a change of physicians attitudes toward patients and their family members control of symptoms, such as pain, for a high quality of life, total care with a team approach, and home care. When the physicians' attitudes become changed, the patient and his or her family would feel that they still retain human dignity and experience the best quality of life with the help of team approach. For the symptom control in terminally ill cancer patients, control of pain is most important and is possible in 97% of patients with opioids. Also, the medical costs are highest in terminal stage of cancer and hospice may be a solution to reduce the cost. The hospice insurance for the terminally ill cancer patients is covered by government in many oriental countries, such as Japan, Hongkong, Singapore, and Taiwan, because it can reduce medical costs and improve the welfare of patients. The joint committee of Korean Society of Hospice·Palliative care, Korean Hospice Care, and Catholic Hospice Care have been asking for the national hospice insurance to the Korean government since 1988, to no effect. In conclusion, the hospice and palliative care should be supported by government as well as medical field.

The Medical Costs in Terminally Ill Cancer Patients

Increasing medical cost due to increasing number of terminally ill cancer patients is very important to be a national issue. Therefore, studies on effective cost reduction are being conducted actively throughout the world. An increase in medical cost means that treatment effect is lagging compared to medical cost. Medical cost includes all expenses used in medicine, and treatment effect is the effect from treating diseases. An analysis of studies in Korea and abroad in the past few years yielded two big issues. The first issue is the comparison between hospital hospice institution and home hospice institution. The second is the comparison between hospice institutions and non-hospice institutions. Many studies done on these two issues revealed that hospice treatment is more effective for the treatment of terminally ill cancer patients, compared with any other treatments. Especially, home hospice provides greater benefits from the economic standpoint. Various factors exist in increasing medical cost in terminally ill cancer patients. These factors in Korea, in short, are 'site of death, medical team, and alternative medicine'. Treatment plan for the terminally ill cancer patients through hospice and palliative care can be the way to solve this problem. On suggestion of this treatment plan, we believe that many cancer patients would rather live their remaining life at home rather than at hospital, So that un-necessary tests and treatments would be minimized, and no money would be wasted on alternative medicine that has not been proven scientifically. Acceptance of death as a natural process by patients and their families will eventually bring about a cost reduction in medicine.

Factors Influencing Pain with Terminally Ill Cancer Patients in Hospice Units / 간호학회지

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. The results of this study were as follows: 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04 +/-2.21), Time 2 (4.82+/-2.58) and Time 3(4.73+/-2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p <0.01) and the opioid use (p <0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p <0.05) and the amount of physical care the participants received (p <0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.