Palliative care team: the first year audit in Japan

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.