Since July 2012, the Palliative Care care internal medicine department has been providing medical care under the banner of "Palliative Care" based on the achievements of the palliative care team that developed from the pain control team established by volunteers in the hospital. In 2012, when our department was established, the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation established the Basic Plan for Promotion of Cancer Control (Phase 2) as an issue to focus on, "promoting palliative care from the time of cancer diagnosis". This is the year we set our sights on, and at our hospital, we have established a system that allows us to provide (1) cancer treatment and (2) palliative care regardless of whether it is inpatient or outpatient.
The World Health Organization (WHO) defines palliative care as “Palliative care is defined as improving the quality of life of patients and their families facing problems related to life-threatening illnesses, pain and other physical, psychosocial and spiritual It is an approach to improve through prevention and relief of pain by discovering serious problems at an early stage, accurately evaluating them, and responding to them.” Palliative care is medical care that can be received at any stage of treatment, with the aim of "becoming able to do things that could not be practiced due to pain".
When it comes to cancer treatment, surgery, radiotherapy, and cancer drug therapy are often regarded as the “three pillars of cancer treatment.” We are committed to improving the lives and quality of life of patients and their families undergoing treatment.
<Features ~ Team medical care starting from outpatient ~>
In the palliative care outpatient clinic, the full-time doctor of the palliative care team work together with the full-time nurses and full-time pharmacists to provide outpatient care. As much as possible, we try to alleviate symptoms in an outpatient setting so that you can spend time at home with peace of mind. By having multidisciplinary involvement at the stage of outpatient care, for example, when starting medical narcotics, we will take care to reduce anxiety as much as possible, and respond so that you can face treatment with peace of mind while alleviating pain. doing.
Medical record
Palliative care team performance table by year
| 2020 | 2021 | 2022 | 2023 | ||||
|---|---|---|---|---|---|---|---|
| outpatient | Total number of patients | 2574 | 2589 | 2276 | 2270 | ||
| new patients | 156 | 164 | 120 | 156 | |||
| Inpatients (total) | Total number of patients | 353 | 374 | 425 | 503 | ||
| cancer patient | whole | number of patients | 319 | 309 | 356 | 375 | |
| Cancer name | Colorectal cancer | number of patients | 19 | 26 | 35 | 25 | |
| stomach cancer | number of patients | 27 | 25 | 23 | 28 | ||
| pancreatic cancer | number of patients | 38 | 34 | 32 | 25 | ||
| gynecological cancer (ovarian cancer, uterine cancer) |
number of patients | 22 | 23 | 40 | 28 | ||
| lung cancer | number of patients | 59 | 68 | 66 | 91 | ||
| hepatocellular carcinoma | number of patients | 14 | 11 | 10 | 21 | ||
| breast cancer | number of patients | 19 | 20 | 17 | 24 | ||
| intervention item (physical symptoms) |
whole | number of patients | 348 | 373 | 420 | 497 | |
| Symptoms (overlapping) | pain | number of patients | 281 | 288 | 316 | 46 | |
| general malaise | number of patients | 16 | 17 | 27 | 36 | ||
| Anorexia | number of patients | 18 | 15 | 22 | 15 | ||
| Nausea/vomiting | number of patients | 15 | 24 | 32 | 30 | ||
| bloating | number of patients | 9 | 14 | 22 | 19 | ||
| difficulty breathing | number of patients | 45 | 56 | 71 | 90 | ||
| Ascites/pleural effusion | number of patients | 5 | 11 | 12 | 8 | ||
| Cough/sputum | number of patients | 3 | 2 | 10 | 9 | ||
| constipation | number of patients | 2 | 2 | 5 | 3 | ||
| lymphedema | number of patients | 0 | 0 | 0 | 1 | ||
| others | number of patients | 9 | 12 | 2 | 7 | ||
| intervention item (mental symptoms) |
whole | number of patients | 134 | 142 | 146 | 215 | |
| Symptoms (overlapping) | anxiety | number of patients | 86 | 99 | 89 | 110 | |
| depression | number of patients | 23 | 17 | 21 | 29 | ||
| delirium | number of patients | 16 | 16 | 21 | 37 | ||
| insomnia | number of patients | 22 | 18 | 30 | 46 | ||
| sleepiness | number of patients | 0 | 0 | 0 | 0 | ||
| others | number of patients | 0 | 0 | 0 | 0 | ||
| physical condition | Activities of daily living (PS) | PS 0: no problem | number of patients | 43 | 33 | 32 | 44 |
| PS 1: light labor is possible | number of patients | 98 | 99 | 96 | 93 | ||
| PS 2: Occasionally Needs Assistance | number of patients | 80 | 87 | 95 | 92 | ||
| PS 3: More than half of the day lying down |
number of patients | 78 | 69 | 103 | 115 | ||
| PS 4: Always need assistance bed all day |
number of patients | 54 | 86 | 99 | 159 | ||
| Outcomes at end of intervention | home discharge (outpatient visit) |
number of patients | 155 | 164 | 189 | 174 | |
| home discharge (Medical care to end-of-life care) |
number of patients | 21 | 34 | 23 | 27 | ||
| General hospital transfer | number of patients | 33 | 30 | 36 | 69 | ||
| Palliative care hospital transfer | number of patients | 57 | 43 | 46 | 48 | ||
| others | number of patients | 18 | 23 | 30 | 48 | ||
| death | number of patients | 69 | 80 | 101 | 137 | ||
| discharge support patient | number of patients | 232 | 223 | 225 | 277 | ||
Departmental statistics
Main diseases/treatments
Treatment target
We treat all painful symptoms associated with serious, life-threatening illnesses being treated at our hospital.
disease unit
Cancer diseases in general
(Example) Gastric cancer, colon cancer, lung cancer, breast cancer, pancreatic cancer, bile duct cancer, hepatocellular carcinoma, prostate cancer, renal cell carcinoma, head and neck cancer, ovarian cancer, endometrial cancer, cervical cancer, leukemia, malignant lymphoma, multiple myeloma, etc.
non-cancer disease
(Example) Non-cancer pain (severe leg ischemia, intestinal ischemia, intractable chronic pain, etc.), chronic heart failure, interstitial pneumonia, complications/aftereffects of new coronavirus infection, etc.
Treatment
We propose and implement medications and care that are deemed appropriate for pain relief.
About medical narcotics
Drugs used include “medical narcotics”. Medical narcotics are important drugs for alleviating painful symptoms such as pain and breathing difficulty.
The word “narcotics” may make you feel uneasy, but since it is a drug developed for medical use, you will not become addicted to drugs if you use it properly.
I think there are "side effects" to worry about. Certainly, as side effects, symptoms such as drowsiness, nausea, constipation, dry mouth, sweating, and hallucinations may occur. Moreover, even if a symptom occurs as a side effect, it is possible to appropriately evaluate and deal with the symptom.
For example, in the case of "cancer pain", it is possible to start with a small amount in a planned manner from the beginning of the pain, rather than using medical narcotics after the pain becomes unbearable.
When using it, please consult with your doctor and use "good medicine" "appropriately".
Palliative Care Support doctor Position and Duties
In the Department of Palliative Care, in collaboration with palliative care specialists who are working on home palliative care in Kobe City, we conduct team rounds for inpatients who need symptom relief.
We hold meetings with supporting doctor before and after rounds to share detailed information, and work under the same prescribing and instruction authority as in-hospital doctor.
Since we ask doctor who are working on home palliative care to support us, we can also get specific advice on recuperation after discharge. Regarding advice, we give neutral advice regardless of the area of activity of the supporting doctor or the environment of the patient or family.
2022 support doctor schedule
(Supporting doctor will conduct team rounds in the circles marked with ○. However, this is subject to change without notice.)
| Mon | Tue | Wed | Thu | Fri | |
|---|---|---|---|---|---|
| morning | ○ | ○ | |||
| afternoon | ○ | ○ |
news
Our hospital has been accredited as a Regional Cancer Treatment Cooperation Base Hospital, and we are focusing on palliative care for cancer patients and their families, but unfortunately we do not have a palliative care ward. . Therefore, at our hospital, we basically cannot accept hospitalization for the purpose of palliative care only, except in an emergency. The Palliative Care /palliative care team also intervenes in collaboration with the treating department. Even if the patient is receiving palliative care at a local medical institution, if the condition requires treatment at our hospital, we will be able to provide same-day treatment in conjunction with the department in charge of treatment. We would appreciate it if you could consult us after creating a request form for the department in charge of treatment and the Palliative Care. However, since we cannot perform nerve blocks at our hospital, we refer patients who are subject to such procedures to specialized institutions as necessary *1).
In addition, for those who need to be hospitalized or admitted to a facility for the purpose of palliative care due to the progression of their condition, we will cooperate with the Regional Medical Cooperation Center of our hospital in advance so that they can transition to treatment without panicking at that time. We also serve as a bridge to medical institutions and nursing care facilities that provide palliative care. We always feel that the power of being at home is very important and precious, and we want our patients to be able to spend their precious time with their families and loved ones in the comfort of their own home (home or facility). We hope that you will continue to receive medical treatment while you are away, but to do so, the support of local medical institutions and nursing homes is essential. Furthermore, we would like to deepen our cooperation with teachers who can support us to stay at home until the end, so we appreciate your cooperation.
*1) Advanced medical institutions with a track record of nerve block consultations from our hospital:
Department of Pain Clinic, Kobe University Hospital
Department of Palliative Care Kobe City Municipal Nishi-Kobe Medical Center
