Nobuhisa Nakajima

A clinical study on the influence of hydration volume on the signs of terminally ill cancer patients with abdominal malignancies.

BACKGROUND Current discrepancies in the practice of artificial hydration therapy for terminally ill cancer patients have the potential to cause serious clinical problems. PURPOSE The studys purpose was to explore the influence of hydration volume on the sings during the last three weeks of life in terminally ill cancer patients. METHODS This was a prospective, observational study of 75 consecutive terminally ill patients with abdominal malignancies during the last four years. Primary responsible physicians evaluated the severity of membranous dehydration (calculated on the basis of three physical findings), peripheral edema (calculated on the basis of seven physical findings), ascites and pleural effusion (rated as physically undetectable to symptomatic), bronchial secretion, and hyperactive delirium. RESULTS Patients were classified into two groups: the hydration group (n=32), receiving 1000 mL or more of artificial hydration per day, one and three weeks before death, and the nonhydration group (n=43). The percentage of patients with deterioration in dehydration score in the final three weeks was significantly higher in the nonhydration group than in the hydration group (35% versus 13%, p=0.027), while the percentages of patients whose symptom scores for edema, ascites, and bronchial secretion increased were significantly higher in the hydration group than in the nonhydration group (57% versus 33%, p=0.040; 34% versus 14%, p=0.037; 41% versus 19%, p=0.036, respectively). There were no significant differences in the degree of pleural effusion or the prevalence of hyperactive delirium between these groups. CONCLUSIONS The potential benefits of artificial hydration therapy should be balanced with the risk of worsening fluid retention signs.

The evaluation of the relationship between the level of disclosure of cancer in terminally ill patients with cancer and the quality of terminal care in these patients and their families using the Support Team Assessment Schedule.

Aims: To examine the relationship between informing patients of cancer and the quality of terminal care. Methods: This was a study of 87 consecutive terminally ill cancer patients who died during the last 27-month period. Notification of cancer was classified into 4 groups (A, B, C, and D, respectively): “nondisclosure,” “disclosure of cancer diagnosis,” “disclosure of life threatening,” and “disclosure of poor prognosis.” We evaluated the quality of palliative care using Support Team Assessment Schedule–Japanese (STAS-J). Results: A, B, C, and D groups included 8, 22, 37, and20 cases, respectively. Regarding physical symptoms, no marked difference was noted. Anxiety was significantly reduced, and the recognition of disease conditions and the level of communication were significantly higher in the groups that received specific information (P < .001). Conclusions: Informing patients of more specific information will increase the quality of terminal care.

Concurrent Specialized Palliative Care Upon Initiation of First-Line Chemotherapy for Cancer Progression: Is It Early Enough?

Purpose: To evaluate the effectiveness of specialized palliative care (PC) administered at the time of administration of first-line chemotherapy for cancer progression. Methods: Patients who received regular specialist PC concomitantly with first-line chemotherapy after being diagnosed with progressive disease assigned to PC group. Patients transferred to palliative care unit (PCU) after discontinuation of chemotherapy were assigned to standard care (SC) group. We evaluated quality of palliative care using Support Team Assessment Schedule, quality of life (QOL) using Good Death Inventory, and short-term mortality in PCU. Results: A total of 28 and 63 patients patients were assigned to PC and SC groups, respectively. Physical symptoms, anxiety, communication scores, and QOL scores were significantly higher in the PC group (P < .001). Short-term mortality (<14 days) was significantly higher in the SC group (P = .0005). Conclusion: This approach may facilitate high quality of PC.

MULTIPLE ILEAL ULCERS AND AN ILEAL DIEULAFOY'S LESION INDUCED BY LOXOPROFEN SODIUM

Loxoprofen sodium is one of the non‐steroidal anti‐inflammatory drugs (NSAIDs) that is a prodrug. Several adverse effects of the drug have been described, but ileal ulcer has not been reported so far. We experienced an 87‐year‐old male patient with disk herniation complicated with loxoprofen sodium‐induced multiple ileal ulcers and an ileal Dieulafoys lesion that caused massive intestinal bleeding. The patient was saved by wedge resection of the Dieulafoys lesion and discontinuance of the NSAID. 99mTc‐red blood cell scintigraphy and intraoperative enteroscopy of the small bowel were useful in the diagnosis. This is the first case of multiple ileal ulcers with an ileal Dieulafoys lesion induced by loxoprofen sodium.

Recent Advances in Palliative Cancer Care at a Regional Hospital in Japan

More than 30 years have passed since the introduction of the concept of palliative care in cancer care in Japan. However, the majority of the estimated three million cancer patients in Japan do not receive palliative care. Higashi Sapporo Hospital was established in 1983 as a hospital specialized in cancer care. The palliative care unit of our hospital currently consists of 58 beds. Our hospital is one of the largest hospitals in Japan in terms of the number of palliative care beds. On admission to our hospital, all patients are evaluated for palliative care by a multi-disciplinary team and some patients who undergo anticancer therapy receive palliative care when necessary. There are about 65 patients on average (28.3%) who are receiving only palliative care. In 2011, 793 patients died of cancer while admitted at our hospital. This number of cancer deaths accounted for 15% of the 5,324 cancer deaths in Sapporo City in the same year. Our hospital has played an active role according to the philosophy that “palliative cancer care is part of cancer medical care”. We here report the current status of the contribution of our hospital to overcoming problems in palliative care and cancer care in Japan.