Pp. 376-389 (14)
Shoji Sunada, Naomi Sanemori, Kei Itagaki, Nobutaka Hatanaka, Yosuke Shimizu and Kikuo Nakano
We describe the significance of the end-of-life care for cancer patients based
on our experience. During the terminal phase of cancer, particularly within the final
two months, physical function rapidly declines and various symptoms appear;
therefore, a prompt response is required to alleviate symptoms. Treatment must be
selected in accordance with the patient’s wishes to reduce their symptoms. Advance
care planning (ACP) is primarily done by the patient and their family, and is sustained
collaboratively by the supporting medical team, and not the unilateral “elicitation of a
commitment” from the patient by the medical staff. ACP increases patient and family
satisfaction during the end-of-life stage, and alleviates anxiety and depression among
survivors after the death of a patient. Performing symptom control during the end-oflife
stage of the patient is important with no demand for explanations. The use of
morphine is recommended as drug therapy for dyspnea. Treatment of death rattle
involves administering anticholinergic drugs and reducing intravenous (IV) infusions.
It is important to provide families with explanations and make considerations for their
inquiries. Routine assessments and corrections must be conducted using a guideline for
intravenous infusions of 1,000 ml or less per day. Unbearable pain can remain in the
end-of-life stage, even after palliative treatment has been performed. In these cases,
sedation is performed after sufficient assessment of pain and after obtaining agreement
from the medical team and consent from the patient and family following an
Advance care planning, End-of-life care, Sedation, Survival
prediction, Symptom control.
Department of Palliative Care, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan.