Palliative Care Service
Introduction
The Palliative Care Service
of the National Cancer Center Hospital East is comprised of three divisions,
the palliative care unit (PCU) for inpatients (25 beds), the clinic for outpatients,
and the telephone consul-tation service. Many patients have visited the clinic
up to the present, and the demand for clinic services is increasing rapidly.
The Palliative Care Service
has programs in inpatient care, home care, consultation, research, volunteer
education, and training. The goal of these six programs is to provide the
highest possible quality of life for patients and their family members. Palliative
care affirms life and regards dying as a normal process. Palliative care emphasizes
the relief of pain and other distressing symptoms. It integrates the physical,
psychological, and spiritual aspects of patient care and offers a support
system to help the patient live as actively as possible until his or her death
and the family cope with stress during the patient's illness and the bereavement
period.
Routine Activities
1. Inpatient care
A total of 333 patients (197
males, 140 females) were admitted to the palliative care unit from January
to December 1999. According to a survey of these patients, 249 (74%) were
referred from the other clinical departments of NCCHE, 28 (8%) were referred
from the National Cancer Center Hospital, Tokyo, and 60 (18%) were referred
from other medical institutions. Lung cancer was the most frequently occurring
primary illness (115 patients: 34%), followed by colorectal cancers (36 patients:
11%), breast cancers (28 patients: 8%), and pancreas cancers (20 patients:
6%). The most common reason for patients'admission was pain, and other reasons
were fatigue, loss of appetite, dyspnea, nausea, and vomiting .The number
of deceased patients was 258 in 1999.
Annual changes in the number
of inpatients in the PCU in the past three years are shown in the first table.
2. Outpatient Clinic
A patient who wishes to receive palliative care at our facility must first register and obtain an application from the outpatient clinic to confirm informed consent. Registration of 341 patients (224 males, 117 females) was completed at the palliative care clinic in 1999. Of the 341 patients, 145 (43%) had been previously treated with surgery, 185 (54%) had received chemotherapy, and 114 (33%) had received radiotherapy. Fifty-eight (17%) had received no treatment, and it was unclear what treatment 4% had received. Following the first consultation, 201 of the 341 patients (59%) were registered on the outpatient list, and 140 (41%) were put on the waiting list for admission. Their primary illness is shown in the second table. Most of the cases had cancers in an advanced stage, with 7% in Stage III, 62% in Stage IV, and 20% experiencing recurrent disease.
3. Telephone Consultation Service
A clinical psychologist is
in charge of the telephone consultation service, which served 586 callers
in 1999. The details of the consultations vary widely, including primarily
information about the PCU, patient care, and cancer treatment. Approximately
80% of the clients are members of patients' families seeking counseling to
relieve the mental anguish of the family.
We started an additional telephone
consultation service staffed by a specialist nurse in October 1994. This service
for patients at home has proved very effective for obtaining information on
the patientfs condition and for providing advice to families. The objective
of the telephone consultation service is to relieve patients and their families
of anxiety and to support domiciliary care. A specialist nurse regularly calls
a patient at home on Monday or Wednesday. In 1999, 105 patients used the service
for 5 to 30 minutes once or twice a week. Consultation is concerned with the
patient's condition, symptoms, anxiety, and other problems of daily life.
The service is also used to make an appointment with a doctor when necessary,
to decide appropriate timing of hospitalization, and to give psychological
support to those who take care of the patient.
New Developments
In 1999, we undertook two clinical
research projects for the treatment of PCU patients. One was a phase I/II
study of octreotide for abating nausea and vomiting caused by an obstructive
condition of the gastrointestinal tract. Twenty-five patients entered into
this study, which was completed in December 1999. The other project was a
study of intravenous hydration for terminal patients.
Two cooperative projects were
started with the Psycho-Oncology Division at the research institute and the
Thoracic Oncology Division at the hospital. The first one is a study of fatigue
in cancer patients. Two hundred patients were registered in this study, which
was completed in November 1999. The second is a study on dyspnea. It is difficult
to measure dyspnea due to its subjective nature and multi-dimensionality,
and the lack of an appropriate assess-ment tool for dyspnea hinders the establishment
of an appropriate management strategy. The purpose of this study was to develop
and validate a brief self-rating scale to assess the multidimensional aspects
of dyspnea. Data was obtained from 166 patients. The present study demonstrated
that the Cancer Dyspnea Scale (CDS) is a brief, valid, and feasible scale
for assessing the multidimensional nature of dyspnea in cancer patients.
|
Number
of Patients Treated at PCU in 1997-1999 |
|||
| @ |
1997 |
1998 |
1999 |
|
Hospitalized |
281 |
300 |
337 |
|
Discharged |
263 |
267 |
333 |
|
Dead |
199 |
211 |
258 |
|
Alive |
64 |
56 |
75 |
|
Diagnosis
of Enrolled Patients at PCU in 1999 (n=341) |
||
|
Diagnosis |
No of pts |
% |
|
Lung
cancer |
122 |
35 |
|
Colorectal
cancer |
30 |
9 |
|
Gastric
cancer |
19 |
6 |
|
Pancreas
cancer |
29 |
9 |
|
Head
& Neck cancer |
23 |
7 |
|
Breast
cancer |
21 |
6 |
|
Others |
97 |
28 |
(Y. SHIMA)
