Background: Lymphoma is one of the most common cancers affecting young adults in Sub-Saharan Africa, yet survival outcomes lag far behind those in high-resource settings. A significant contributor to these disparities is treatment abandonment, driven by limited access to essential palliative care support and lack of symptom management medications. This study aimed to assess the feasibility and early uptake of a Symptom Toolkit intervention to support symptom recognition and self-management. Methods: We designed and implemented a novel, low-cost, culturally appropriate Symptom Toolkit into an oncology clinic in Malawi. The toolkit included nurse-delivered patient education and take-home essential therapies targeting high-burden symptoms, including pain, nausea and vomiting, insomnia, gastritis, mucositis, and constipation, with pictorial labels and a journal to record use. Included therapies were selected based on local clinical guidelines and availability. At follow-up visits, a palliative care nurse completed survey assessments and distributed new Symptom Toolkits, noting both symptom occurrence and rates of medication use. Results: A total of 65 patients with lymphoma (median age 39) participated, including individuals with acute lymphoblastic leukemia, Burkitt lymphoma, diffuse large B-cell lymphoma, and Hodgkin’s lymphoma. Across the 602 toolkit reports completed, use of symptom-directed medications increased over time, indicating improved uptake and engagement with the intervention. Conclusions: This pilot intervention demonstrates the feasibility of a nurse-delivered Symptom Toolkit as a means to enhance symptom recognition and self-management in a low-resource oncology setting. Further evaluation of the Toolkit in future studies will assess its impact on symptom burden and quality of life.
Home-based palliative care for patients with advanced heart failure remains challenging because refractory dyspnea and hemodynamic instability often require continuous medical support. Continuous dobutamine infusion is occasionally used to facilitate discharge to home in patients with end-stage heart failure; however, symptom relief with inotropic therapy alone may become insufficient during the terminal stage of illness. Reports describing the combined use of home dobutamine infusion and opioid therapy remain limited, particularly in Japan. We report two elderly patients with advanced heart failure who wished to spend their remaining time at home and were managed with continuous home dobutamine infusion combined with opioid therapy for symptom palliation. Case 1 involved an 84-year-old man with cardiac amyloidosis, severe mitral regurgitation (MR), and low cardiac output syndrome. Despite guideline-directed medical therapy and transcatheter edge-to-edge mitral valve repair, progressive fatigue and heart failure symptoms persisted. Continuous home dobutamine infusion was initiated, and transdermal fentanyl was subsequently added because of worsening dyspnea and discomfort. The patient remained at home and died 99 days after discharge. Case 2 involved a 91-year-old woman with advanced valvular heart disease, severe tricuspid regurgitation, pulmonary hypertension, and recurrent heart failure hospitalization. After temporary stabilization with dobutamine and symptom-oriented treatment, she was discharged home with continuous dobutamine infusion and opioid therapy. Although she died 5 days after discharge, her wish to remain at home was fulfilled. These cases suggest that combined home-based dobutamine infusion and opioid therapy may represent a feasible symptom-oriented palliative care strategy for selected patients with advanced heart failure who strongly prefer home-based end-of-life care. Further studies are needed to clarify patient selection, symptom outcomes, and safety considerations.
Background:Opioid-induced constipation is a practical bowel-management issue when opioids are started for cancer pain, but real-world naldemedine timing and subsequent laxative needs remain variable. Objective:To describe naldemedine initiation timing/context after oxycodone start and early additional laxative adjustment among adults with cancer. Design:Single-center retrospective cohort study using routine clinical records. Setting/Subjects:Adults with cancer pain in a single-center Japanese cancer-care setting who started oxycodone between June 1, 2017, and December 31, 2018, and subsequently received naldemedine. Measurements:Concurrent initiation was naldemedine prescribed as part of the same oxycodone-start prescribing decision; reactive initiation was naldemedine added as a separate prescribing decision after physician-recognized constipation during ongoing oxycodone therapy. The primary outcome was prescription-record-based additional laxative initiation or dose escalation of existing laxatives within 7 days after naldemedine initiation. Secondary outcomes were oxycodone-to-naldemedine interval and diarrhea-related discontinuation within 28 days. Results:Among 101 patients, the primary outcome occurred in 6/31 (19.4%) concurrent and 2/70 (2.9%) reactive cases (p = 0.010). The reactive group had a median oxycodone-to-naldemedine interval of 15 days (interquartile range, 5-83); diarrhea-related discontinuation occurred in 2/31 (6.5%) versus 6/70 (8.6%). Conclusions:Concurrent naldemedine at oxycodone start did not eliminate early additional laxative initiation or escalation. Naldemedine timing should be understood within individualized bowel-management planning, with conventional or rescue laxatives considered when clinically appropriate.
Background:General ward nurses increasingly care for patients with advanced cancer; however, the implementation of evidence-based nursing support remains unclear. Multicenter palliative care unit (PCU) surveys quantified nursing practices for major cancer-related symptoms and caregiver burden using systematically developed item sets; however, findings from PCU settings may not directly generalize to general wards, given differences in staffing, patient populations, and resources. Objectives:To describe the frequency of nonpharmacological nursing for five cancer-related symptoms (pain, dyspnea, nausea/vomiting, constipation, and delirium) and family caregiver burden provided by general ward nurses in Japan. Methods:We will conduct a multicenter, cross-sectional, web-based survey (Jan-Mar 2026) in designated cancer care hospitals nationwide. Registered nurses working in general wards will report their opportunities to provide symptom-related support in the past 12 months and the frequency of specific practices on a 5-point Likert scale. Item sets are based on scoping reviews and prior PCU surveys and will be refined through pretesting with general ward nurses. Primary outcomes are proportions reporting frequent use of each item; analyses will summarize overall and symptom-specific distributions, excluding respondents with no opportunity. Target sample size is 1,300-1,500, estimated using dyspnea and accounting for clustering. Expected Implications:This study will provide nationally representative evidence on nursing support practices in general wards. The findings will inform targeted educational strategies by identifying potential gaps suggested by the observed frequencies of reported practices and enabling contextual interpretation in relation to prior PCU findings, thereby supporting future interventions, strengthening evidence-based palliative care.
