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While a sensation of thirst causes severe distress for a certain proportion of cancer patients in the terminal stage, the factors contributing to this symptom have not been established. To clarify the association between sensation of thirst and medical factors, especially dehydration, a cross-sectional observational study was performed on terminally ill cancer patients receiving inpatient hospice care. On admission to a palliative care unit, 88 consecutive patients underwent blood sampling and were requested to rate the intensity of thirst on a visual analogue scale (VAS). Physicians prospectively evaluated factors that might potentially be contributing to the symptom. The mean VAS score for thirst was 5.0+/-2.8, and 18% of the patients complained of severe thirst with a VAS score of > or = 8. No significant correlations were observed between the VAS score for thirst and the values of total protein, blood urea nitrogen (BUN), creatinine, sodium, osmolality, hematocrit, atrial natriuretic peptide (ANP), and biochemical dehydration defined by the levels of BUN, creatinine, sodium and osmolality. On the other hand, dehydration defined by ANP level (< or = 15 pg/ml), hyperosmolality (> or = 300 mosmol/kg), gastrointestinal cancer, survival, performance status, oral intake, vomiting, and stomatitis were significantly associated with the severity of thirst. In addition, mouth breathing and opioids were determined to be a potential clinical cause of severe thirst when a retrospective chart review was carried out. In conclusion, sensation of thirst is a frequent symptom in terminally ill cancer patients and is associated with dehydration, hyperosmolality, poor general conditions, stomatitis, oral breathing, and opioids. Careful assessments and treatment of underlying causes is important to alleviate patients' distress.

In Japan, palliative care team (PCT) services have been covered by National Health Insurance since 2002. The primary aims of this study were to compare the characteristics of patients who received PCT services with those admitted to palliative care units (PCU), and to clarify the medical treatments and symptom improvement during the first week after consultation with the PCT. This was a prospective audit study of 111 consecutive cancer patients referred to the PCT in Seirei Mikatabara Hospital and a comparison group of 100 consecutive patients admitted to PCU. As a part of daily practice, we prospectively recorded patient symptoms on a structured data collection sheet at the initial assessment and one week later. Symptom severity was measured by the Japanese version of the Schedule for Team Assessment Scale. After PCT consultation, 25% were discharged to home, 43% died in hospital, 40% died after admission to PCU, and 14% were alive at the end of the study period. Compared with PCU patients, PCT patients were significantly younger, had better performance status, were more likely to be referred with the described aim of symptom palliation, and suffered from more serious pain, appetite loss, somnolence, insomnia, anxiety, and delirium. There were significant improvements in symptom scores of pain, nausea, vomiting, constipation, abdominal swelling, dyspnea, sputum, insomnia, and anxiety during the first week in the PCT group. However, no significant improvements were observed in symptom scores of fatigue, dry mouth, somnolence, and delirium. A median of 3 interventions was performed for each patient, and the most common interventions were administration of NSAIDs, opioids, centrally-acting antiemetics, and steroids. These data indicate that a PCT was successfully implemented in Seirei Mikatabara Hospital, and may contribute to symptom improvement in cancer patients.

PICCs were safely inserted in about 90% of terminally ill cancer patients within about 20 minutes. Although 30% of the patients experienced transient mild procedure-related distress, more than 90% of the patients felt that the parenteral route was more comfortable and convenient after the procedure. PICCs may provide a safe, comfortable, and convenient alternative for terminally ill cancer patients, if placement of the PICC is individualized to the patient situation and after alternatives are considered. Further studies are needed to compare the superiority of the PICC and traditional subcutaneous route to clarify what types of patients are the most suitable for each procedure.