[Measures to Raise Awareness on Home Care Medicine for Staff at an Acute Medical Care Facility - Multi-Professional Collaboration on the Strengths Dissemination Project].

Kohka Public Hospital(KPH)focuses primarily on the treatment of acute diseases. However, as the only general hospital in the medical district and established under the National Health Insurance, KPH has a mandate in comprehensive medical care. With the aim of becoming a hospital that can cope with the anticipated super-aging society, a meeting was started to raise staff awareness of home care medicine. Senior managers were placed in each team along with staff with no involvement on the issue. Initially, a SWOT analysis was conducted to understand the current status. Views raised in the meetings will be summarized, and consequent measures will be announced both internally and externally as part of the Strengths Dissemination Project. Interest in home care medicine at acute medical care hospitals is undeniably low, but the reality is that many do not know how to get involved due to the lack of exposure. It is unquestionable that the need for home care medicine and regional cooperation will rise in our nation. We must direct the attention of health care providers there and start discussions.

[Choice of Expiration for Cancer Patients under Home Medical Care - Palliative Care Unit or Home].

Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems.

Prevalence and risk factors of bone metastasis and skeletal related events in patients with primary breast cancer in Japan.

BACKGROUND: Bone metastasis (BM) is important for studying systemic spread of breast cancer. It often causes skeletal-related events (SREs) that worsen quality of life. We investigated the prevalence and risk factors for BM and SRE using a dataset from the Breast Oncology Research Network (BORN) in Japan. PATIENTS AND METHODS: We collected data on primary breast cancer patients with node-positive or node-negative disease at intermediate to high risk of recurrence. The risk factors affecting the BM-free rate, SRE-free rate and overall survival were analyzed by using the Cox proportional hazard model. RESULTS: Data of 1,779 patients who were diagnosed with breast cancer during 2003-2005 were collected from the BORN and 1,708 cases were used for analysis. The median follow-up duration was 5.71 years. BM developed in 193 cases (11.3 %) and the BM-free rate at 5 years was 89.2 %. The annual hazard ratio of BM development differs remarkably according to the tumor subtype. SREs occurred in 133 (68.9 %) out of 193 patients and the SRE-free rate at 5 years was 92.6 %. In the multivariate analysis, clinical stage (P < 0.0001), number of lymph node (LN) metastases (P = 0.0029), tumor subtype (P = 0.034) and progesterone receptor status (P = 0.038) were independently significant risk factors for BM-free rate, but only clinical stage (P < 0.0001) and number of LN metastases (P = 0.0004) significantly correlated with SRE-free rate. CONCLUSIONS: This retrospective study clarifies the prevalence and risk factors for BM and SRE in Japanese breast cancer patients. Our results show the importance of considering subtype in the care of BM and SRE.

[Present status of regional collaboration of home care medicine at Kohka Medical County(Kohka-City and Konan-City), Shiga prefecture].

The importance of home care medicine has been well recognized by the National and Prefectural policy. We have conducted several meetings on home care medicine and discussed various problems and barriers that need to be overcome. These meetings were held with various professionals. The meetings, however, were conducted with little communication between professionals, especially regarding cancer and non-cancerous lesions. The members who perform the home care medicine are the same persons regardless of the regions they are from. We are, therefore, trying to improve the communication between these professionals in order to consolidate these meetings. We have recognized and understand the present status of home care medicine through these meetings and are willing to make efforts to improve the home medical practice and care.

[Home care for cancer patients previously treated at other medical facilities].

Nine cancer patients who were treated at other medical facilities were referred to the Kohka Public Hospital (KPH) to receive further cancer treatment or terminal care. Of these patients, 7 were men and 2 were women, and their mean age was 58.8 years. All the patients had unresectable cancer invasion or metastases. Their Eastern Cooperative Oncology Group performance status was either 3 or 4. Six of the 9 patients were first admitted to KPH and then discharged to home care. Two of these 6 patients died at home. The other 4 patients were ultimately re-admitted. The problem was that prognosis was not predicted accurately in some of these patients. Two of the 9 patients were managed by home care and died on days 8 and 13 after the initiation of home care. One patient returned to the previous hospital with the hope of receiving further treatment and palliative care. Patient information had to be available at presentation to all persons involved in the management of the patient and we had to prepare for patient care. Additionally, patients should be informed about serious conditions and poor prognosis without delay.

[The present status of home care medicine and regional medical co-operation at a regional cancer base hospital].

Kohka Public Hospital(KPH), approved as a regional cancer base hospital in February 2008, has concentrated on cancer treatment and care. KPH developed a Division of Home Care Medicine last year. A home care doctor visited and treated various patients, including cancer patients by co-operating with the Visiting Nurse Station; this resulted in an increase in home care patients but not of home deaths. To increase the cases of home care medicine, we believe that collaboration with other institutes and the creation of a regional network conference consisting of doctors, nurses, pharmacists, dental doctors, home helpers, and regional administrators is necessary. Via the conference, we recognized the need to obtain more information and create a system of collaborative home medication and care for cancer patients.

[The present situation of cancer patient's death at home whereas the hospital primarily engages in acute physical disorders].

Kohka Public Hospital(KPH), located in the southeast district of Shiga Prefecture, has been recognized for playing a major role in the care of acute physical disorders. KPH is also expected to have a central role in cancer treatment in the regional medical district. We have practiced home care on terminal cancer patients since before the establishment of palliative care team at KPH in 2008. The Visiting Nurse Station treated a total of 82 terminal cancer patients from 2008 through 2010 fiscal year. Of these 23 patients we cared for died at home. On the other hand, the Division of Regional Medical Collaboration carried out 23-home visit medication for last 2 years(2009-2010). Of these 23-home visits, they cared for 7 patients who died at home. The majority of the patients, as well as families, wished that they would have liked to be re-hospitalized at KPH in their terminal stage. Under the consideration of these results, we established a Division of Home Care Medicine this year and would intend to cooperate and to take care of the cancer patients not only at KPH, but also at various other places in cooperation with the regional medical resources and welfare after creating a medical network system for cancer treatment and care.

Bi-weekly docetaxel in the adjuvant treatment of node-positive or high-risk breast cancer patients: phase I study of the Shiga Breast Cancer Study Group.

BACKGROUND: A phase I study of bi-weekly docetaxel was performed to determine the maximum tolerated dose (MTD) as well as the incidence and severity of toxicities in patients with high-risk node-negative and node-positive breast cancer. METHODS: Docetaxel was administered every 14 days to postoperative breast cancer patients who were axillary lymph node-positive or considered at high-risk. After the completion of six cycles of docetaxel, all patients received epirubicin + cyclophosphamide every 21 days for four cycles. The docetaxel dose was escalated in a stepwise fashion as follows: 45, 50, 55, 60, 65, and 70 mg/m(2) in levels 1, 2, 3, 4, 5, and 6, respectively. Patients were treated in cohorts of three to six per group using a standard phase I study design. The MTD was considered the dose level at which three of three patients or more than three of six patients experienced dose-limiting toxicity (DLT) in the first cycle. RESULTS: Twenty patients were enrolled and received a total of 110 cycles of chemotherapy. The MTD was not reached until level 5. Since three DLTs (grade 3 diarrhea, n = 2; grade 3 constipation, n = 1), were observed in five patients at level 6, level 6 was judged as the MTD. The recommended dose of bi-weekly docetaxel for a phase II trial is 65 mg/m(2). CONCLUSIONS: The MTD of bi-weekly docetaxel was 70 mg/m(2). Further evaluation is warranted to confirm the safety and efficacy in the treatment of early-stage breast cancer.