Evaluation of Palliative Care for Terminal Gastric Cancer by Gastroenterological Surgeons

Yoichi Nakamura, Jiro Nagao, Shinya Kusachi, Yoshihisa Saida, Manabu Watanabe, Yasushi Nakamura, Toshiyuki Enomoto, Miwa Katagiri, Sayaka Nagao and Ryohei Watanabe

Third Department of Surgery, Toho University School of Medicine

Introduction: We evaluated terminal gastric cancer conducted treatment by a palliative care-team led by gastroenterological surgeons. Methods: Subjects were 53 patients with terminal gastric cancer divided into two groups a preteam group of 18 cases prior to setup of the palliative-care team and a postteam group of 35 cases after palliative-care team setup. We evaluated the difference in treatments between groups. Results: Pain recorded on patients' charts and pain management accounted for 61.1% in the preteam group and 85.7% in the postteam group. Dosage along with WHO's pain ladder was applied in 58.3% of preteam group and 96.7% of the postteam group. Measures agains adverse opioid reactions such as nausea and constipation were taken in 18.2% of preteam group and 79.2% of the postteam group. To control nausea and vomiting, continuous subcutaneous administration of octreotide acetate and haloperidol were applied in 40% of the postteam group. No cases required reinsertion of short or long tubes. To manage generalized fatigability and anorexia, steroid was given in 11.1% of the preteam group and 54.3% of the postteam group. Average fluid administration preceding the day of patients' death was 1,361.7 ml in the preteam group and 816.2 ml in the postteam group; the amount decreased due to worsening general condition. Subcutaneous fluid administration was selected based on the patient's general condition. At the patients' last hospital admission, high-calorie fluids were administered in 27.8% of the preteam group and decreased 11.4% in the postteam group. Discussion: Gastroenterological surgeons well recognize the needs of patients in palliative care, So analgesics, including opioids are used appropriately to control gastrointestinal symptoms and to manage fluids and nutrition.

Key words
palliative medicine, opioid, gastric cancer

Reprint requests
Yoichi Nakamura Third Department of Surgery, Toho University Ohashi Medical Center
2-17-6 Ohashi, Meguro-ku, 153-8515 JAPAN

Accepted
September 24, 2008

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