Terminal Stage Cancer Patients Research Articles

ONCOLOGY NURSES’ ATTITUDES CONCERNING DYING WITH DIGNITY PRINCIPLES AND RELATED FACTORS

REFERENCES Ay, F., Gençtürk, N. (2013).Midwifery student’s opinions related to death, terminal period and palliative care: focus group study. Florence Ni̇ghti̇ngale Journal of Nursing, 21(3):164-171. Baillie, L. (2009). Patient dignity in an acute hospital setting: a case study. International Journal of Nursing Studies, 46(1): 23–36. Benner, P., Kerchner, S., Corless, I. B., Davies, B. (2003). Attending death as a human passage: core nursing principles for end-of-life care. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 12(6), 558–561. Çelik, N. (2019).The intensive care nurses’ attitudes toward of death and principles about die with dignity. Mersin University Journal of Health Sciences, 12 (2): 316-327 Çevik, B., Kav, S. (2013).Attitudes and experiences of nurses toward death and caring for dying patients in Turkey.Cancer Nursing, 36(6):58–65. Dağ, A., Badır, A.(2017).The effects of certain characteristics of physicians and nurses on attitudes related to principles about dying with dignity. Journal Dokuz Eylul University Faculty of Nursing,10(4), 186-192. Demir, A., Sançar, B., Yazgan, E.Ö., Özcan, S., Duyan, V.(2017).i Intensıve care and oncology nurses’ perceptıons and experıences wıth ‘futıle medıcal care’ and ‘prıncıples of good death’. Turkish Journal Of Geriatrics,20(2):116-124. Duyan, V. (2014)Reliability and validity study on the assessment of attitudes towards principles about die with dignity. Turkish Journal of Family Medicine and Primary Care; 8(1): 25–31 Duyan, V., Serpen, A. S., Duyan, G., & Yavuz, S. (2016). Opinions of Social Workers in Turkey About the Principles on Die with Dignity. Journal of Religion and Health, 55(6), 1938–1953. Guo, Q., Jacelon, C.S. (2014).An integrative review of dignity in end-of-life care. Palliative Medicine,28(7), 931–940. Hasgül, E.(2017, April ). Opinions of home care students about respectable death principles IV. International Multidisciplinary Congress of Eurasia Proceedings., Barcelona, Spain. Işıkhan, V.(2008). Choices of death place in terminal stage cancer patients. Turkish Journal Of Oncology. 23(1): 34-44. Kennedy,G.(2016).The Importance of Patient Dignity in Care at the End of Life. The Ulster Medical Journal, 85(1):45–48. Kızılkaya, M., Koştu, N. (2006).The concept of death in the elderly and nursing approach. Journal of Atatürk University School Of Nursing,9(4):69-74. Ko, E., Kwak, J., Nelson-Becker, H. (2015). What constitutes a good and bad death?: perspectives of homeless older adults. Death Studies, 39(7): 422–432. Matiti, M.R., Trorey, G. (2004). Perceptual adjustment levels: patients’perception of their dignity in the hospital setting. International Journal of Nursing Studies, 41(7): 735-744. Pierson, C. M., Curtis, J. R., Patrick, D. L. (2002). A good death: a qualitative study of patients with advanced AIDS. AIDS Care, 14(5), 587–598. Staats., K, Christensen, K., Grov, EK., Husebø, BS., Tranvåg, O. (2022). Healthcare professionals' perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway. J Women Aging,Sep-Oct;34(5):567-581. Tehranineshat, B., Rakhshan, M., Torabizadeh, C., Fararouei, M. (2020). Patient dignity in iranian clinical care settings as perceived by physicians, caregivers, and patients. J Multidiscip Healthc, Sep (16);13:923-933 Thomas, C., Morris, SM., Clark, D. (2004). Place of death: preferences among cancer patients and their carers. Social Science & Medicine, 58(12):2431–2444. Uzunkaya Oztoprak, P., Terzioglu, F. (2021). Attitudes of oncology nurses towards care of dying patients and the principles of dying with dignity and their views on good death. Omega, 302228211057743 World Health Organization.int [homepage on the internet]. Cancer. [Cited 2023 October10]. Available from: https://www.wma.net

10259-NQPC-9 CONTROVERSY ON INVASIVE AIRWAY MANAGEMENT IN PATIENTS WITH BRAIN STEM MALIGNANT GLIOMA.

Abstract INTRODUCTION The prognosis for patients with malignant gliomas of the brainstem is poor. As the tumor progresses into the medulla oblongata, the lower cranial nerves are affected, resulting in dysphagia and eventually respiratory paralysis. On the other hand, higher cerebral function is often preserved, making it a palliative medical issue whether to perform invasive procedures to secure the airway. We report here three characteristic cases treated at our hospital. CASE 1 A-60-year-old male patient with diffuse midline glioma of the medulla oblongata was admitted to our hospital for radiation therapy and concomitant temozolomide. His consciousness level was clear, but dysphagia was noted. Although he was at risk for aspiration and choking, he did not wish to undergo surgery to prevent aspiration. After treatment was started, he died of choking. CASE 2 A-50-year-old male patient with recurrent astrocytoma in the brainstem was admitted for bevacizumab monotherapy. Despite the treatment, his dysphagia gradually worsened, and he developed respiratory failure due to aspiration pneumonia, resulting in tracheal intubation. Subsequently, he underwent glottis closure, and as a result, he lost his speech but recurrence of aspiration pneumonia and choking were prevented. CASE 3 A-50-year-old male patient with cerebellar glioma invading brainstem was admitted due to aspiration pneumonia. He was disoriented and required heavy care. He did not wish to undergo surgery to prevent aspiration, but with antimicrobial therapy and frequent oral suctioning, his aspiration pneumonia was cured. DISCUSSION Although invasive procedures are generally avoided in terminal-stage cancer patients, anti-aspiration procedures such as tracheostomy and glottis closure may be considered for the conscious patients with malignant glioma in the brainstem. These procedures might be an option at the end of life to avoid painful death due to choking and to prevent deterioration of the patient's condition due to repeated aspiration pneumonia.

Affecting burden and cost of care for the caregiver of dependent patients with advanced stage of cancer who had an arrangement for expected death at home.

e24000 Background: The terminal stage cancer patients suffer from disease and related therapeutic processes, lead to increasing need for caring from their caregivers. This affects the quality of life(QOL) of caregivers. Currently, there is no data on burden of caregivers who caring for cancer patients who are choose to die at their home. Objective: This study examined burden of caregivers, impact on QOL and satisfaction of caregivers for patients with terminal cancer, comparing in the group of patients who die at home versus at hospital, comparing in regular care group(RC) versus palliative care group(PC). Methods: The semi-qualitative-quantitative study enrolled caregivers of advance cancer patients who had PPS < 60 at Ramathibodi Hospital from Dec 2021-Nov 2022. We assessed participants on 3-time-points (enrolment, 1, 2 months) for QOL and burden via telephone interviews, questionnaires by EQ5D5L and Zarit Burden. If the patients passed away, we interviewed caregivers in qualitative study. Analysis responses were recorded, transcribed and organized thematically analyzed. Analysis stratified on care with palliative care or not, and place of death. Results: We enrolled 108 participants, child (56%) and spouses (29%). They spent carring time average of 16.56 hr/day. 52 patients have passed away: home death(34) and hospital death(18). No significant difference in burden score and QOL between RC and PC. Burden score significantly increasing when time of death approach in both groups. However, significantly higher satisfaction score in caregivers of patients who died at home(P < 0.001). In patient who died in hospital, early integrated palliative showed significantly higher satisfaction score(P = 0.046). Qualitative analysis revealed 3 primary themes, 1) caregiver burden is increasing and chronic stress condition until the death of their loves and still continue post their death 2) need more help in coping and nursing strategies, more early palliative care can relieve their distresses 3) opinion of the caregivers in group of hospital death, If they could turn back time, they would have promised to look after their lovers better in changing the pass away at their home. Conclusions: Caregivers for terminal cancer patients have a high burden. However, caregiver of patients who died at their home rather have more satisfaction. Early integrated palliative care improves satisfaction in caregiver of patients who died at hospital. [Table: see text]

Comparison of 50 Cases of the Anti-Cancer Effects of NaCl with KCl as a Potent Graphene Exfoliator, Prehydrated Patients to NaCl-Only Prehydrated Patients on the Terminal Stage Cancer Patients

Comparison of 50 Cases of the Anti-Cancer Effects of NaCl with KCl as a Potent Graphene Exfoliator, Prehydrated Patients to NaCl-Only Prehydrated Patients on the Terminal Stage Cancer Patients

Hospice Care Improves Patients’ Self-Decision Making and Reduces Aggressiveness of End-of-Life Care for Advanced Cancer Patients

The aim of the current study is to evaluate the different degrees of hospice care in improving patients' autonomy in decision-making and reducing aggressiveness of cancer care in terminal-stage cancer patients, especially in reducing polypharmacy and excessive life-sustaining treatments. This was a retrospective cross-sectional study conducted in a single medical center in Taiwan. Patients with advanced cancer who died in 2010-2019 were included and classified into three subgroups: hospice ward admission, hospice shared care, and no hospice care involvement. In total, 8719 patients were enrolled, and 2097 (24.05%) admitted to hospice ward; 2107 (24.17%) received hospice shared care, and 4515 (51.78%) had no hospice care. Those admitted to hospice ward had significantly higher rates of having completed do-not-resuscitate order (100%, p < 0.001) and signed the do-not-resuscitate order by themselves (48.83%, p < 0.001), and they had lower aggressiveness of cancer care (2.2, p < 0.001) within the 28 days before death. Hospice ward admission, hospice shared care, and age > 79 years were negatively associated with aggressiveness of cancer care. In conclusion, our study showed that patients with end-of-life hospice care related to higher patient autonomy in decision-making and less excessively aggressive cancer care; the influence of care was more overt in patients approaching death. Further clinical efforts should be made to clarify the patient and the families' satisfaction and perceptions of quality after hospice care involvement.

Truth-Telling to Terminal Stage Cancer Patients in India: A Study of the General Denial to Disclosure.

Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients' autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members' preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients' family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care.

Inhibition of TGF\u03b2 improves hematopoietic stem cell niche and ameliorates cancer-related anemia

BackgroundCancer cachexia is a wasting syndrome that is quite common in terminal-stage cancer patients. Cancer-related anemia is one of the main features of cancer cachexia and mostly results in a poor prognosis. The disadvantages of the current therapies are obvious, but few new treatments have been developed because the pathological mechanism remains unclear.MethodsC57BL/6 mice were subcutaneously injected with Lewis lung carcinoma cells to generate a cancer-related anemia model. The treated group received daily intraperitoneal injections of SB505124. Blood parameters were determined with a routine blood counting analyzer. Erythroid cells and hematopoietic stem/progenitor cells were analyzed by flow cytometry. The microarchitecture changes of the femurs were determined by micro-computed tomography scans. Smad2/3 phosphorylation was analyzed by immunofluorescence and Western blotting. The changes in the hematopoietic stem cell niche were revealed by qPCR analysis of both fibrosis-related genes and hematopoietic genes, fibroblastic colony-forming unit assays, and lineage differentiation of mesenchymal stromal cells.ResultsThe mouse model exhibited hematopoietic suppression, marked by a decrease of erythrocytes in the peripheral blood, as well as an increase of immature erythroblasts and reduced differentiation of multipotent progenitors in the bone marrow. The ratio of bone volume/total volume, trabecular number, and cortical wall thickness all appeared to decrease, and the increased osteoclast number has led to the release of latent TGFβ and TGFβ signaling over-activation. Excessive TGFβ deteriorated the hematopoietic stem cell niche, inducing fibrosis of the bone marrow as well as the transition of mesenchymal stromal cells. Treatment with SB505124, a small-molecule inhibitor of TGFβ signaling, significantly attenuated the symptoms of cancer-related anemia in this model, as evidenced by the increase of erythrocytes in the peripheral blood and the normalized proportion of erythroblast cell clusters. Meanwhile, hindered hematopoiesis and deteriorated hematopoietic stem cell niche were also shown to be restored with SB505124 treatment.ConclusionThis study investigated the role of TGFβ released by bone remodeling in the progression of cancer-related anemia and revealed a potential therapeutic approach for relieving defects in hematopoiesis.

Korean Medicine Treatment for Pressure Injury in Terminal Stage Cancer Patients with Debridement and Local Flap: A Case Report

Korean Medicine Treatment for Pressure Injury in Terminal Stage Cancer Patients with Debridement and Local Flap: A Case Report

Novel CTC test followed by iodine therapy for the terminal stage of cancer patients.

e15661 Background: 5 years of survival rate of stage IV cancer patients have kept poor for these 30 years. This is mainly due to inevitability of anti-cancer drugs for them because of multi-organ metastasis. We developed a novel CTC technique to identify CTCs responsible for metastasis, and provided a method to kill those dangerous cells by Iodine therapy. Methods: We did 314 CTC tests, and 53 patients received it more than twice (average prognosis of 4.5 months). Our CTC tests by flouring 4cc blood of the patients into a special device with &gt; 50,000 pores of 8μ diameters, this device can only catch CTCs. We also stained with cytokeratin and vimentin anti-bodies (see table). Iodine water was made of 10,000 ppm of NaI with certain numbers of additional chemicals. This preclinical trial was accepted by our ethical committee. Results: We developed a novel CTC technique to catch 95% of CTCs and identified 3 types of CTCs (see table). Without any therapy, type 1 cells disappeared, while all patients with type 2 cells died within a couple of months, this may be due to EMT (epithelial mesenchymal transformation) on them. We tested certain numbers of ant-cancer drugs and found that no drugs can kill type 2 cells, only stable Iodine water provided by our clinic can kill type 2 cells perfectly within two months, and 51 out of 53, the terminal stage of patients can survive more than a year. Conclusions: Novel CTC test can identify 3 types of CTCs and type 2 cells can be responsible for the poor survival of terminal stage cancer patients because they are responsible for metastasis, and anti-cancer drugs cannot kill them. It has been well-known that Iodine induces PPARγ which can promote apoptosis of type 2 cells and inhibit EMT. Iodine may improve their poor prognosis.[Table: see text]

Abstract 4854: A translational multiplexed hypothesis generating study on circulating cytokines in patients with cancer cachexia

Abstract Cancer cachexia is a frequent pathophysiological state associated to terminal stage cancer patients, characterized by a significant reduction in body weight and resistant to nutritional interventions. It is an unmet medical need, and its underlying mechanisms are not completely understood. Objectives: To measure multiple soluble cytokines in patients with cachexia, to develop new hypotheses on pathways and/or eventual therapeutic targets. Methods: This is part of a pilot, observational, cross-sectional, case-control, IRB-reviewed translational research in cancer patients with/without cachexia. Anthropometric, clinical and biochemical data from consenting eligible cancer patients were collected. Blood samples were collected from all the participants, and plasma was separated and immediately stored at -20°C until analysis. For this substudy, human 63-plex kits were purchased from eBiosciences and used according to the manufacturer's recommendations. Plates were read using a Luminex 200 instrument, and the assay was performed in the Human Immune Monitoring Center at Stanford University (CA, USA). Data were analyzed by univariate and multivariate methods, using error adjustments for multiple testings (False Discovery Rate, FDR). A total of 15 subjects were included in this study, 8 cachectic and 7 non-cachectic patients. Median age in cachectic group was 61.5 (36-81) years versus 63.9 (48-80) in non-cachectic group. The respective relative weight loss within the prior 3 months was 17.6% and 1.0%. Clinical, analytical and metabolomics from these patients have been reported elsewhere (doi: 10.1002/jcsm.12270). Of the 63 cytokines tested in our panel, 18 have been selected for fold-change (FC) analysis: for 12, their log2(FC)&amp;gt;1 (IL1RA, ENA78, IL8, GROA, IL23, MCP1, BDNF, PDGFB, IL18, IL21, RESISTIN, IL6), being the FC &amp;gt; 10x for IL1RA, ENA78, IL8, GROA and IL23. For the remaining 6, their log2(FC) &amp;lt; -1 (LEPTIN, GMCSF, IL12P40, IL1B, CD40L, IL5). The cytokines selected for their FDR were: LEPTIN, LIF, GMCSF, RESISTIN, TNFA, IL1B, IL12P40, IL4, IL12p70, BDNF, IL2, IL5, IL23, IL17A and IL13. We integrated these results with prior metabolomics research and performed pathway analyses that enabled us to identify a significant enrichment in several pathways related with infections, immune response, inflammation, energy homeostasis and cancer. This study, despite the size constraints, is able to capture known players in cancer cachexia (leptin, IL6, IL1). We show a potential role for BDNF (brain derived neurotrophic factor), which and has been described as a master coordinator of the physiological mechanisms that regulate food intake and energy expenditure, and identified as a player in murine models for cancer cachexia. Results from this study will be integrated with data from additional research in the same patients (clinical, analytical, metabolomics and proteomics). Citation Format: Mª Teresa Agullo-Ortuño, Virginia Pardo-Marques, Elena Prieto-Garcia, C. Vanesa Diaz-Garcia, Irene Otero, Jose A. Lopez-Martin. A translational multiplexed hypothesis generating study on circulating cytokines in patients with cancer cachexia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4854.

Effects and safety of mechanical bathing as a complementary therapy for terminal stage cancer patients from the physiological and psychological perspective: a pilot study.

In palliative care hospitals in Japan, mechanical bathing is conducted to maintain cleanliness. However, the physiological and psychological influence of mechanical bathing on patients has not been sufficiently studied. The objective of this study was to assess, using physiological and psychological indices, the effects of mechanical bathing care for patients in the terminal stage of cancer. Mechanical bathing was performed using a Marine Court SB7000 in a supine or semi-seated position. The heart rate variability analysis method was used to measure autonomic nervous system function. The patients' state of anxiety was assessed using the State-Trait Anxiety Inventory (STAI), a psychological index, and patients' verbal responses were also collected after mechanical bathing. Twenty-four patients were enrolled in this study. Their sympathetic and parasympathetic nervous activity did not differ before and after bathing. A significant difference was found between pre- and post-bathing anxiety, as evaluated by STAI (P < 0.0001). In the patient's verbal responses that was collected, the most frequently mentioned descriptors were 'comfortable' and 'relaxed'. Patients were more relaxed after mechanical bathing according to STAI evaluation and their verbal responses. The findings suggest that the method of bathing used in this study is safe and pain-relieving for terminal stage cancer patients. It is thus possible to provide safe and comfortable care for terminal stage cancer patients using mechanical baths.

Applicability of end of life needs assessment tool at a multicultural Turkish hospital

Improving the quality of life in terminal stage cancer patients and their families are at utmost importance. The End of Life Needs Assessment Form is adapted from Palliative Performance Scale; to assess patients' needs toward the end of their life. We studied for the first time the practicality, applicability and usefulness of this tool in a unique Turkish hospital providing services to patients from extensive number of countries in this region.

Combined Effect of Opioids and Corticosteroids for Alleviating Dyspnea in Terminal Cancer Patients: A Retrospective Review

ABSTRACTDyspnea is a prognostic factor that affects the quality of life of terminal cancer patients, and many reports have described opioid treatment for dyspnea alleviation. Here, we retrospectively evaluated differences in the effects of various opioids administered concomitantly with corticosteroids on dyspnea in 20 terminal-stage cancer patients (13 men, 7 women; mean age [range]: 71 [49–94] years) who received opioids concomitantly with corticosteroids. Effectiveness was assessed throughout administration using the Support Team Assessment Schedule, Japanese version (STAS-J), particularly the subscale indicating how strongly a patient is affected by symptoms. The effectiveness of combined opioid and corticosteroid therapy against dyspnea and the opioid dose comprised the primary and secondary foci, respectively. Among concomitantly treated patients, STAS-J scores at initiation (mean ± SD: 3.1 ± 0.24) and lowest recorded STAS-J scores (1.4 ± 0.22) differed significantly (P = .0034) among those receiving morphine, but not among those receiving oxycodone (P = .068) or fentanyl (P = .18). Concomitant opioid and corticosteroid treatment was associated with a ≥2-point STAS-J score improvement in 14/20 patients (effectiveness: 70%). The opioid dose did not significantly affect dyspnea alleviation. We conclude that concomitant opioid and corticosteroid treatment can effectively alleviate dyspnea in terminal cancer patients.

Loneliness of oncology patients at the end of life.

Terminal stage cancer patients experience anxiety about death and pessimism about the future. They usually fear that as they approach death, their pain will increase, they will lose their reputation, and they will be alone. However, few studies have evaluated the loneliness that these cancer patients feel. This was a cross-sectional and definitive study that evaluated the feeling of loneliness in terminal cancer patients. In total, 55 cancer patients with terminal cancer who were hospitalised for palliative therapy between 14 November 2014 and 14 January 2015 in the Okmeydanı Training and Research Hospital were included in the study. The patients were given a questionnaire form that included sociodemographic properties and University of California Los Angeles Loneliness Scale to collect data. Loneliness was detected as 53.61±9.29. There was no relationship between sociodemographic data and loneliness (p>0.05). Regression analysis revealed that family support and sharing of emotional stress were related to the level of loneliness (p<0.05). More than half of the patients needed psychological support because they could not handle the situation. Terminal stage cancer patients felt lonely in general, and patients with a lack of visitors and family support experienced a higher level of loneliness.

Evaluation of Terminal-Stage Cancer Patients Needing Palliative Care in the Emergency Department

Aim: There are many difficulties in providing palliative care in the emergency department (ED). However, emergency physicians have to be qualified in palliative care. The aim of this study was to describe the characteristics of palliative care patients admitted to the ED and to determine the current state of such patients in the ED. Materials and Methods: The study included 153 terminal-stage cancer patients who needed palliative care and were admitted to the ED over a period of a year. The demographic characteristics, complaints, time duration in the ED, and characteristics of multiple admissions to the ED were evaluated. Results: The mean age of the patients was 69±3 years and the male/female ratio was 1.3. The most common complaint was nausea-vomiting (37%), followed by pain (32%). Lung cancer was the most common cancer type. Furthermore, 47.7% of the patients had multiple admissions to the ED. The hospitalization rate decreased as the number of admissions increased. Conclusion: EDs play an important role in the management of palliative care patients. The importance of palliative care should be emphasized to increase emergency physicians’ knowledge, experience, and skills about providing proper care to these patients. (JAEM 2015; 14: 12-5)

Investigational tests and treatments performed in terminal stage cancer patients in two weeks before death: Turkish oncology group (TOG) study.

Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients' characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16-96) years. More than half of the patients (370, 59.3%) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2%), lung (24.0%), and breast (11.1%). Frequent metastatic sites were liver (34.8%), bone (31.5%), lung (23.3%), and/or brain (16.9%). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4% of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8% of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5% of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0% of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4% of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics.

The Evaluation of Terminal Stage Cancer Patients Needing Palliative Care in Emergency Department

The Evaluation of Terminal Stage Cancer Patients Needing Palliative Care in Emergency Department

Investigational tests and treatments performed in terminal-stage cancer patients in two weeks before death: Supportive care study group in Turkish Oncology Association.

e20503 Background: Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures and treatment is given instead. Methods: Between ...

Study on the factors determining home death of patients during home care: A historical cohort study at a home care support clinic

Associations between markedly low activities of daily living (ADL) at the start of home visit care and patient home death were analyzed using data from a home care support clinic in Japan that has a low rate of home deaths. The study was a historical cohort study. It involved patients who began to receive home visit care from a home visit care support clinic between 1 April 2006 and 31 March 2011. Using home death as a dependent variable and presence/absence of markedly low ADL and other parameters (cancer, the patient's desire for home death, etc.) as independent variables, the adjusted hazard ratio and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Markedly low ADL were associated with home death even after adjustment for factors that influence home death (adjusted hazard ratio 4.40; 95% CI 2.37-8.16). Cancer and the patient's desire for home death were statistically significant factors involved in home death. In a subgroup analysis according to the presence/absence of cancer, the association between markedly low ADL and home death was stronger in the cancer-free group (adjusted hazard ratio 10.78; 95% CI 2.89-40.26) than in the cancer group (adjusted hazard ratio 5.58; 95% CI2.39-13.05). Patients' desire for home death could be fulfilled if home care support clinics provide home visit services to not only terminal-stage cancer patients, but also bedridden cancer-free patients. We must establish systems for older adults to remain at home during the terminal period of their lives.

Rationale of Combined PDT and SDT Modalities for Treating Cancer Patients in Terminal Stage—The Proper Use of Photosensitizer: A Reply

a. The main sensitizer used, Sonoflora 1 (SF1), was supplied by SonneMed LLC, (Marlborough, NH). They have published zebra fish assay data indicat­ ing no evidence of toxicity. b. To further enhance SPDT therapeutic efficacy, we have developed 2 new sensitizers, SFa and UF. All 3 are chlorin e6 based, and all showed no detect­ able side effects during multiple animal tests. c. Prior to use in clinical practice, the 3 sensitizers had been tested by The Drug Quality Research Institute, Guangdong Province, China, to verify safety for human use. Tests conducted by the insti­ tute showed that mice tolerated the sensitizers very well even at dosages 250 times higher than the dose used in our clinic. An official certificate has been issued allowing us to produce and commer­ cially use our sensitizer as foodstuff. d. Our ultrasound device also had been tested by a government laboratory and found to be safe for human use. e. Colleagues at the Dove Clinic using a similar treatment protocol have also not found any safety problems. f. So far we have used SPDT with various combina­ tions of SF1, SFa, and UF to treat 81 patients with terminal cancer. We have safely conducted SPDT treatment more than 1000 times. SPDT is almost always well tolerated. The main side effects are (reversible) mild pain in tumor areas, tiredness, and weakness. Compared with chemotherapy and radiation therapy, it has almost no toxicity. SPDT does not induce photosensitive dermatitis, which may occur in conventional photodynamic therapy (PDT). SPDT shows none of the hand and foot syndromes that can occur with molecular target therapeutic drugs.