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>

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.

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

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.