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国立がん研究センター 中央病院

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Department of Palliative Medicine

Eriko Satomi, Hiroto Ishiki, Kaoru Nishijima, Daisuke Kiuchi, Masaki Shimizu, Koutarou Nomura

Introduction

 The palliative care service started with a palliative care team of multidisciplinary professionals (palliative care specialists, psychooncologists, certified nurses, pharmacists, psychologists, Hospital Play Staff, acupuncturists) in the National Cancer Center Hospital (NCCH) in 1999 and the Department of Palliative Care and Psychooncology was established in 2010 with the reorganization of the NCCH. In 2013, the Department of Palliative Medicine started.

The Team and What We Do

 We provide palliative care to patients and their families as members of the palliative care team collaborating with primary doctors, nurses, and other professionals to create an individualized palliative care plan. Our goals are:

  • Relieve pain and other physical symptoms
  • Focus on patients' emotional and spiritual concerns, and those of their caregiver
  • Coordinate patients' care
  • Improve the quality of life of patients with cancer
  • Advance care planning

Research activities

 We are participating and conducting multicenter observational studies and interventional studies for supportive and palliative care, and continuously planning palliative care research for the innovation of palliative care.

Clinical trials

 JORTC-PAL08 (Efficacy of duloxetine for cancer patients with neuropathic pain: Double blind, Randomized, Placebo controlled, exploratory trial), PHASE-R (Naldemedine for opioid-induced constipation: observational study), J-SUPPORT 1603 (Nurse-led, screeningtriggered early specialized palliative care intervention program for advanced lung cancer patients randomized controlled trial), EASED (East-Asian collaborative Study to Elucidate the Dying process), etc.

Education

 We have two training courses for doctors who will be palliative care specialists and for residents to learn primary palliative care. All the surgical and medical oncology residents in the NCCH need the knowledge and skills about primary supportive and palliative care in oncology. They participate in our team for four weeks and undergo on-the-job training for palliative medicine. It includes an opportunity to attend home hospice rounds in cooperation with the Chuo-ku Medical Association. A total of 20 residents finished the four-week palliative medicine course in 2018. One short-term resident and one chief resident registered for the specialized palliative care education course. They learned specialist palliative care in oncology including physical, psychosocial, and spiritual supportive care during anti-cancer therapy as well as end-of-life care, and support for patients' decision making and advance care planning.

Future prospects

 We will continue to provide qualified palliative cancer care with an integrated palliative care model in clinical practice throughout the continuum of a person's disease, regardless of whether it is early or later in the course of the disease. And we will enhance our palliative care education program for specialists and oncologists. We also continuously conduct high-level palliative care research in order to strengthen evidence to improve palliative care practice.

List of papers published in 2018

Journal

1. Mori M, Fujimori M, Ishiki H, Nishi T, Hamano J, Otani H, Uneno Y, Oba A, Morita T, Uchitomi Y. The Effects of Adding Reassurance Statements: Cancer Patients' Preferences for Phrases in End-ofLife Discussions. J Pain Symptom Manage, 57:1121-1129, 2019

2. Mori M, Fujimori M, Ishiki H, Nishi T, Hamano J, Otani H, Uneno Y, Oba A, Morita T, Uchitomi Y. Adding a Wider Range and "Hope for the Best, and Prepare for the Worst" Statement: Preferences of Patients with Cancer for Prognostic Communication. Oncologist, 24: e943-e952, 2019

3. Morita T, Kiuchi D, Ikenaga M, Abo H, Maeda S, Aoyama M, Shinjo T, Kizawa Y, Tsuneto S, Miyashita M. Difference in Opinions About Continuous Deep Sedation Among Cancer Patients, Bereaved Families, and Physicians. J Pain Symptom Manage, 57:e5-e9, 2019

4. Ishiki H, Yamaguchi T, Matsumoto Y, Kiuchi D, Satomi E. Effect of early palliative care: complex intervention and complex results. Lancet Oncol, 19:e221, 2018

5. Ishiki H, Kinkawa J, Watanabe A, Watanabe C, Chiba T, Yasui H, Shimada N, Ariyoshi K, Nojima M, Iwase S, Tojo A, Imai K. Prevalence of myofascial pain syndrome in patients with incurable cancer. J Bodyw Mov Ther, 22時32分8-332, 2018