[Choice of Expiration for Cancer Patients under Home Medical Care - Palliative Care Unit or Home].

Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems.

[Home care for cancer patients previously treated at other medical facilities].

Nine cancer patients who were treated at other medical facilities were referred to the Kohka Public Hospital (KPH) to receive further cancer treatment or terminal care. Of these patients, 7 were men and 2 were women, and their mean age was 58.8 years. All the patients had unresectable cancer invasion or metastases. Their Eastern Cooperative Oncology Group performance status was either 3 or 4. Six of the 9 patients were first admitted to KPH and then discharged to home care. Two of these 6 patients died at home. The other 4 patients were ultimately re-admitted. The problem was that prognosis was not predicted accurately in some of these patients. Two of the 9 patients were managed by home care and died on days 8 and 13 after the initiation of home care. One patient returned to the previous hospital with the hope of receiving further treatment and palliative care. Patient information had to be available at presentation to all persons involved in the management of the patient and we had to prepare for patient care. Additionally, patients should be informed about serious conditions and poor prognosis without delay.

[The present status of home care medicine and regional medical co-operation at a regional cancer base hospital].

Kohka Public Hospital(KPH), approved as a regional cancer base hospital in February 2008, has concentrated on cancer treatment and care. KPH developed a Division of Home Care Medicine last year. A home care doctor visited and treated various patients, including cancer patients by co-operating with the Visiting Nurse Station; this resulted in an increase in home care patients but not of home deaths. To increase the cases of home care medicine, we believe that collaboration with other institutes and the creation of a regional network conference consisting of doctors, nurses, pharmacists, dental doctors, home helpers, and regional administrators is necessary. Via the conference, we recognized the need to obtain more information and create a system of collaborative home medication and care for cancer patients.