Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Mar 2010
Case Reports[Successful management of a patient with pain and dyspnea from bone metastasis and lymphangitis carcinomatosa after surgery for non-small cell lung cancer (NSCLC) in whom optimal dosages of transdermal fentanyl were determined by titration with fentanyl injection, and oxycodone hydrochloride].
With recent progress in disease-modifying treatments for cancer, patients who have recurrences during a period of several years before entering the terminal stage are encountered frequently. Despite improved life expectancy with cancer therapy, for patients this means prolongation of the period in which various symptoms such as cancer pain and adverse reactions are undergone. In these conditions, although the recognition is not yet sufficient, the importance of palliative care along with disease-modifying treatment is recognized in Japan. ⋯ The dosages after titration were transdermal fentanyl 35 mg, oxycodone hydrochloride 60 mg, and betamethasone 4 mg. Before her death, she was able to stay at home with her family for 3 days without severe symptoms. In the present study we describe the clinical course of this case, the difference of characteristics in these opioids, and the titration method with fentanyl injection.
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Gan To Kagaku Ryoho · Feb 2010
Case Reports[The role of psychosomatic medicine doctors in palliative care medicine--two case reports].
Palliative care medicine deals with the issue of death by listening to the story of patient's lives. There are several problems such as stress overload or burnout due to the difficulty in responding to all demands from patients and the shortness of time. These problems sometimes make doctors specializing in palliative care have less interest in patients, negative feelings or an indifferent attitude to them. ⋯ Psychosomatic medical doctors have an advantage in that they can contribute to palliative care without stress overload or burnout because of their special training in communication skills to deal with patients from the standpoints of both mind and body. However, these doctors have not received psychiatric training so as to be able to diagnose precisely and treat psychiatric problems such as adjustment disorders, depression and delirium. Therefore, their further training in psychiatry for several months or years is an issue to be addressed in future.
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Gan To Kagaku Ryoho · Feb 2010
[Diagnosis and treatment for bone metastases--multidisciplinary team medicine by cancer board].
With the recent progress in cancer treatment making longer survival possible, the need of treatment for bone metastases has become indispensable to assure patient QOL(quality of life). Treatment and prevention of fracture and spinal cord injury are very important not only to maintain good QOL but also to improve survival. Early diagnosis of the risks and the prevention and treatment of fracture and spinal cord injury are necessary. An orthopedics-based team approach to establishing an effective and intensive diagnosis and treatment system for bone metastases is called for Cancer Board.
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In Japan, a pain relief for terminally ill cancer patients has been improved greatly in the past twenty years owing to the appearance of several new opioids and manuals available, loosening the usage of opioids legally, and so on. Medical institutions including clinics which are involved in home palliative care have the knowledge and techniques in certain levels. ⋯ Though very few, certain clinics can do the continuous subarachnoid morphine injection using subcutaneous indwelling port. Considering that home palliative care including pain control required a professional knowledge and techniques, it is necessary to establish a new system in the district which enables to provide the palliative care of high quality by a team in which palliative care clinic or PCC exists as the main medical center.