Communicating the discontinuation of anticancer treatment to patients is a difficult task. The primary aim of this study was to clarify the level of oncologist-reported burden when communicating about discontinuation of an anticancer treatment. The secondary aims were (i) to identify the sources of burden contributing to their levels and (ii) to explore the useful strategies to alleviate their burden. A multicenter nationwide questionnaire survey was conducted on 620 oncologists across Japan (response rate, 67%). High levels of perceived burden were reported by 47% of respondents, and 17% reported that they sometimes, often or always wanted to stop oncology work because of this burden. There was a significant association between high levels of burden and: a feeling that breaking bad news would deprive the patient of hope; concern that the patient's family would blame the oncologist; concern that the patient may lose self-control; and a feeling that there was not enough time to break the bad news. Strategies perceived to be useful by oncologists included training in how to effectively communicate to patients discontinuation of anticancer treatment, a reduction in total workload to allow sufficient time to break bad news, and development of a multidisciplinary model to facilitate cooperation with other professionals and facilities. Many oncologists reported high levels of burden relating to communication of discontinuation of anticancer treatment. A specific communication skills training program, sufficient time for communication and development of a multidisciplinary model could help alleviate the burden on oncologists.

There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model. A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method. Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation. We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research.

Background and Objective: Delirium in terminally ill cancer patients causes considerable distress to family members. The aim was to determine the family-perceived usefulness of a leaflet about delirium in terminally ill cancer patients. Methods: Family members received a leaflet about delirium designed for this study as a part of routine practice. Questionnaires were mailed to bereaved family members of cancer patients recruited from three palliative care units, one hospital palliative care team, and three specialized home care teams in Japan. Results: Among 235 family members, 16 questionnaires were returned as undeliverable, and responses were obtained from 169 bereaved family members (response rate 77%, 169/219). Of these, 22 were excluded because of missing data and 34 families reported they did not recognize that the patient had delirium, and thus 113 responses were finally analyzed. As a whole, 81% of the family members reported that the leaflet was “very useful” or “useful.” Many respondents noted that the leaflet “helped them understand the dying process” (84%), “helped them identify what they could do for the patient” (80%), “helped them understand the patient's physical condition” (76%), and “was useful in preparing for the patient's death” (72%). Conclusions: The leaflet about delirium was evaluated as useful for family members. This leaflet could help family members cope with a difficult situation by facilitating accurate understanding of the situation and by helping family members understand what they could do for the patient. More comprehensive intervention programs should be developed and tested in the future.