Palliative Care Service

Introduction
The Palliative Care Service has programs in inpatient care, outpatient clinics and home care, consultation, research, volunteer, education and training. The goal of the 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 relief of pain and other distressing symptoms. It integrates 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 patient's illness and the bereavement period.

Routine Activities 
The Palliative Care Service of the National Cancer Center Hospital East (NCCHE) comprises three divisions, the palliative care unit (PCU) for inpatients (25 beds), the clinic for out patients and the telephone consultation service.
1. Inpatient cares
A total of 337 patients (194 males, 143females) have been admitted at the palliative care unit from January to December 2002. Lung cancer was the most frequently occurring primary illness (111 patients: 33%), followed by head and neck cancers (34 patients:10%), gastric cancers (29 patients:9%), pancreas cancers (26 patients: 8%), colorectal cancers (32 patients: 9%), breast cancers (18 patients: 5%) and prostate cancers (12 patients: 4%). The most common reason for patients' admission was pain(58%), and other reasons were fatigue (49%), loss of appetite (38%), dyspnea (33%), delirium (22%), nausea and vomiting (16%). 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 enroll and obtain an application from the outpatient clinic to confirm informed consent. Registration of 494 patients ( 298 males, 196 females) was completed at the palliative care clinic in 2002. According to a survey of these patients, 361 (78%) were referred from the other clinical departments of NCCHE, 45(9%) from the National Cancer Center Hospital, Tokyo, and 60 (12%) from other medical institutions. Of the 494 patients, 251(51%) had been previously treated with surgery, 341 (69%) had received chemotherapy, 26(5%) had received hormonal therapy, and 225 (46%) received radiotherapy. Following the first consultation, 285 (58%) of the 494 patients had been registered on the outpatient-list, and 209 (42%) were put on the waiting list for admission. Their primary illness is shown in the Table. Most of the cases had cancer in an advanced stage, with 4% in Stage III, 84% in Stage IV and 25% experiencing recurrent disease.
3. Telephone Consultation Service
This service for patients at home has proved very effective for obtaining information on the patient's condition and for providing advice to families. A specialist nurse regularly calls a patient at home on Monday or Wednesday. In 2002, 102 patients (68 males,34 females) jused 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 2002
Hospice clinicians and nurses have traditionally stressed that the routine use of artificial hydration does not always contribute to patient comfort, while many patients receive a large amount of intravenous hydration in hospitals just before death. In 2000, we performed a survey of physicians attitudes toward terminal dehydration and intravenous hydration for terminally ill cancer patients. Physicians have considerably divergent attitudes. In 2002, we performed the investigation of nurses attitudes toward artificial hydration treatment. Of the 4210 nurses to whom questionnaire were mailed, 3498 returned. (response rate= 83 %, 3498/ 4210 ). in this survey , our primary aim was to clarify nurses' attitudes toward artificial hydration therapy for terminally ill cancer patients and to compare with physicians' attitudes.
A continuous subcutaneous infusion (CSCI) is an extremely useful method of drug administration, particularly suited to palliative care. The devices are not problem-free. Mechanical problem, reactions at the infusion site and difficulties with the mixing of drugs in the syringe are all widely recognized. In this study, we review some general issues with the operation of portable syringe drivers, and make out the flow chart for solving problems with CSCI by syringe driver.

Y. SHIMA

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