JSCO2016: International Session 14 Palliative Care

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)

International Session 14: Palliative Care


Treatment guidelines in Japan
Etsuko Aruga (Department of Palliative Medicine, Teikyo University School of Medicine)
The Japanese Society of Palliative Medicine publishes several Japanese clinical guidelines in Japanese that are for the pharmacological management of cancer pain (1st edition in 2010 and 2nd edition in 2014), dyspnea (1st edition in 2011 and 2nd edition in print), gastrointestinal symptoms (1st edition in 2011), urological symptoms (1st edition in 2008 and 2nd edition in print), sedation (1st edition in 2010), and parenteral hydration therapy (1st edition in 2013). These guidelines follow the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Pharmacoeconomic considerations are not included in their recommendations. On the basis of 65 recommendations, guidelines for cancer pain have stated treatments with non-opioid analgesics for mild pain considering prevention of peptic ulcer, initiation of opioid analgesics for residual pains with measures for adverse events, opioid titration, preparation of short-acting opioids for breakthrough pain, opioid switching for inadequately controlled pain, and alternative systemic routes of opioid administration. Combination with adjuvant analgesics may be used for neuropathic pain. Patients should be educated about cancer pain management. Other guidelines for parenteral hydration therapy in cancer patients with fluid retention recommend fluids less than 1000 ml/day. Further, the updated version of these guidelines for the management of dyspnea in cancer patients will be shown in this session.


Cancer pain management in Japan: From conservative to interventional treatments
Seiji Hattori (Department of Cancer Pain Management, The Cancer Institute Hospital)
Cancer pain occurs in 80% of the cancer patient and sometimes its severity destroys QOL and may lead to disruption of humanity. There are various methods in managing cancer pain.
Conservative pain treatment has been well established by WHO guideline and pursued by Palliative Care Society in each countries. But one should always have in mind that conservative pain treatment has its limit in severe, intractable, and humanity destroying pain regardless of sky high dosing of opioids and adjuvant pain medications.
In this session, I will focus on CANCER PAIN MANAGEMENT from conservative treatments to interventional treatments in Japan.
I will introduce
①Brief history of opioid and analgesics: How it came into Japan and go on to ②currently available analgesics in Japan, oral medication to parenteral administration. May talk about some barriers to enforce cancer pain treatment in our country.
Additionally, I will introduce how we, as a Department of Cancer Pain Management, plan ③pain management strategies to severe cancer pain patient. We are capable of enforcing neurolysis and spinal analgesia to the patient in intractable pain regardless of systemically given high dose opioids. We often start with epidural morphine PCA which gives swift pain relief in critically painful situation. Secondary, we consider how to make it simple; reduce dose and number of analgesics, seek chance for neurolysis, and may proceed to intrathecal analgesia.

The purpose is to show audience and participants, generally, what kind of analgesics are available in Japan, and what kind of other therapy is possible in Japan.


Palliative care year in review from Europe: A growing global community of integrated oncology and palliative care
Florian Strasser (Head Oncological Palliative Medicine, Clinic Oncology / Hematology, Cantonal Hospital St. Gallen, Switzerland)
Integration of palliative care interventions into cancer care is moving forward in the variable and multicultural European landscape. Both the mapping of palliative care development in Europe and the ESMO designated centers (DC) of integrated oncology and palliative care document an increasing integration. A recent survey of the ESMO DC describe characteristics of these centers, levels of integration according to previously published citeria, and also a new initiative (InSupC) investigating integrated palliative care practices. Palliative care at home, in nursing homes, and specific needs of family caregivers and also the effect of volunteers are tackled. Emphasis is given mainly in UK to integrate patient’s outcomes in routine care, placing emphasis also patient’s different illness trajectories and associated challenges on prognostication, on identifying complexity, on comorbidities as well as characteristics of the elderly cancer patient. Studies involving dozend of european countries shed light on national variablity, also manifest in variable prevalence of advanced directives. Interest is placed on patients with palliative care needs or death in the Emergency Room (ER), and characteristics of patients with frequent ER visits. Interest is increasing to understand better palliative care in hemato-oncology and palliative care, including symptom epidemiology (multiple Myeloma) and palliative care needs as well as appropriate interventions. Increasing awareness is directed to omptimizing decicions on anticancer treatment in patients close to end of life, and those being frail,due to comorbidities, cancer-complications or geriatric syndromes. Multinational symptom symptom data compared symptoms, functional status and age and investigated influence of depression on symptoms. Several pharmacological and educational interventions for pain, delirium or ascites were conducted. Prospective studies explored patients’ values close to death and determinants of meaning in life. Spiritual care in middle east was investigated,
In summary, a broad spectrum of activities highly relevant for cancer care.


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