Palliative Care Service

Introduction
The Palliative Care Service has programs for 1) inpatient care, 2) outpatient clinic and home care, 3)consultation, 4) research works, 5) volunteers, and 6) 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 patientis view of life and regards dying as a normal process. Also it emphasizes relief of pain and other distressing symptoms. It integrates, therefore, the physical, psychological, social 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 period of patientis illness and the bereavement.

Routine Activities　
The Palliative Care Service of the National Cancer Center Hospital East (NCCHE) comprises followingthree divisions, the palliative care unit (PCU) for inpatients (25 beds), the clinic for outpatients and the telephone consultation service. Many patients have visited the clinic up to the present, and the demand for clinical services has been increasing rapidly in these days.
1. Inpatient cares
A total of 333 patients (189 males, 144 females) have been admitted at the PCU from January toDecember 2001. Lung cancer was the first rank primary illness (112 patients: 33%), followed by head and neck(40 patients: 12%), gastric (23 patients: 7%), pancreas cancers (20 patients: 6%), colorectal cancers (21 patients:6%), breast (25 patients: 7%), and prostate cancers (6 patients: 0.2%). The most common reason for patientsi admission was pain (66%), and the other reasons were fatigue (49%), loss of appetite (32%), dyspnea (39%),nausea and vomiting (20%). In 2001, we have increase of 45 patients in total compared with the number of patients treated in 2000 (see Table).
2. Outpatient Clinic
A patient who wishes to receive palliative care at our facility must be registered at the outpatient clinic,after the confirmation of informed consent that he or she was given p by answering the specific application form. In 2001, we had registration of 491 patients (317 males, 174females) at the outpatient clinic. Of the 491 patients, 395 (80%) were referred from the other clinics in NCCHE,39(8%) from the National Cancer Center Hospital, Tokyo, and 57 (11%) from the other medical institutions. Of the 491 patients, 217 (44%) had been previously treated with surgery, 297 (60%) with chemotherapy, 35 (7%)with hormonal therapy, and 217 (44%) with radiotherapy. After the first consultation of 491 patients, 338 (69%)had been registered on the outpatient-list of PCU, and 153 (31%) were put on the waiting list for admission. The primary illnesses of these patients are shown in Table. Most of them were in far advanced stage, with 7% in Stage III, 78% in Stage IV of which one third were with recurrent disease, and the rest 15% was unclear.
3. Telephone Consultation Service
This service has proved very effective to support patients at home. A specialist nurse regularly calls.articular patients for obtaining the information on the patientsi conditions and for providing adequate advices to families on Monday or Wednesday. In 2001, 126 patients (67 males, 59 females) used the service for 5 to 30 minutes once or twice a week. Consultation is referring to the patientis condition, symptoms, anxiety, and the 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 2001, we completed a clinical research for assessing the efficacy of Support Team Assessment Schedule(STAS) in Japanese version, which we had drawn up two years ago for quickly assessing the qualities and activities of clinical practice in palliative care. The STAS, which had been originally developed in UK in community settings, is now widely used in both inpatient and community settings in many countries. Measurescales, which we developed, are now confirmed of their validity and adaptability for using as outcome measures.
In this study, inter-rater reliability was assessed by determining the proportion of individuals on the clinical team who had same rating and by Sperman rank correlations between individuals on the team. For each clinical case, the proportion of individuals on the same team who had the same total score was not greater than 20%. The majority of the proportions were in the range of 0.77-0.93. The result proved inter-rater reliability to be satisfactory.

Y. SHIMA

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