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Vol.49 No.4 contents | Japanese/English |
 | Full Text of PDF (2834K) Article in Japanese |
- Review Article -
Home Palliative Care -Analysis of 553 Terminal Cancer Cases-
Takashi Oiwa11Medical Corporation Shuseikai Sakusabesakadori Clinic, Japan
Objective. To promote an understanding of home palliative care, and to demonstrate that it is the most appropriate choice for treatment in the terminal stage of cancer, especially lung cancer. Method. We analyzed the following factors related to care quality in 553 patients who received home palliative care: 1) mortality at home, 2) maintenance of walking ability, as an ADL-related factor, 3) communication using spoken language, 4) maximum narcotic dose and change in dose at end of life, as an assessment of the alleviation of suffering (e.g., pain, dyspnea). Results. 1) Mortality at home was 96.1% overall (lung cancer: 96.3%, non-lung cancer: 96.1%). 2) Examination of walking ability in patients who had been able to walk on their own at the start of home care revealed that, overall, 46.4% and 32.6% of the patients had gone to the bathroom, albeit with assistance, 2 days before death and on the day before death, respectively (lung cancer: 45.2% and 35.5%, respectively; non-lung cancer: 46.9% and 31.5%, respectively). 3) Examination of communication in patients who had been able to talk at the start of home care revealed that, overall, 87.3% and 75.7% of the patients were capable of communicating using spoken language 2 days before death and on the day before death, respectively (lung cancer: 86.0%, and 76.9%, respectively; non-lung cancer: 87.8% and 75.2%, respectively). 4) 165 of the patients, or 34.9%, did not use narcotics to alleviate their suffering, and the symptoms of most of those who used narcotics were alleviated by 200 mg/day or less of oral morphine equivalents. Moreover, the doses were not increased at the end of life in most of the patients. Conclusion. It was demonstrated that terminally ill cancer patients can be cared for at home until they die, and that the quality of care received at home is high. Home palliative care should therefore be actively promoted as the preferred method of care in terminal-stage cancer patients.
key words: Home palliative care, QOL, Relief of suffering, Support of autonomy, Lung cancer
JJLC 49 (4): 339-348, 2009
