[Barriers upon providing assistance and making arrangements for being discharged from hospital and changing hospitals while undergoing cancer therapy - when in a state of depression (from the perspective of a psycho-oncologist) - part 5].

In the final stages of cancer, home care becomes difficult because the patients face reduced physical strength and energy, people around them have physical and mental fatigue, and available medical treatment options are exhausted. Although there are many underlying factors, prolonged depression is also mentioned as a cause of the difficulties of home care. This paper reports on one case in which we reaffirmed the most important factor of homecare - preventing a feeling of isolation for patients who wish to stay at home even if they are experiencing depression.

[Barriers to providing assistance and making arrangements for being discharged from the hospital or changing hospitals while undergoing cancer therapy for patients in a state of depression--perspective of a psycho-oncologist (Part 4)].

In the treatment of cancer, living at home for as long as possible is an important aspect. During home care, many patients experience symptoms of dementia, depression, adjustment disorder, and mental disorder. There are 3 critical stages: the initial announcement of the diagnosis of cancer, the announcement of the occurrence of relapse, and the announcement regarding the lack of effective treatment.

[How to treat a home cancer patient when the patient encountered with delirium symptom].

It has been 5 years since the passage of the Basic Act on Countermeasures against Cancer and the Promotion of Cancer Countermeasures. In 2012, the early stage of cancer treatment was desired based on the revision of these master plans for all cancer patients as well as their families. One third of the 1 million annual deaths were caused by cancer in Japan, and predicted that the cancer mortality ratio has been increasing in trend.

[Deliria: an obstacle to continue home care--from the perspective of psycho-oncologist].

It has been 2 years since the 2007 Cancer Control Act(Table 1)and the Basic Plan to Promote Cancer Control was implemented, which aimed at a reduction of burden for all cancer patients and their families and to improve a quality of life. The Basic Plan to Promote Cancer Control requires an active engagement, such as alleviation of physical symptoms and mental/psychological problems for not only in the terminal phase of a patient but also from an early phase of treatment. Specifically, our primary aim was to relive the mind of patient's family by providing information on cancer prevention, education, and things that matter most to the family were handled through training of medical staff, palliative care, consultation and care support, and other related services.

[Barriers upon providing assistance with making arrangements for discharging and changing from hospitals while a patient is undergoing cancer therapy--when he is in the state of depression (from the perspective of psycho- oncologist)].

During a cancer therapy, a fine-tuned response is necessary for a patient to stay home with family for a longer period of time. Especially the patient is near the end of life. Based on the Basic Plan to Promote Cancer Control programs, our hospital established a cancer consulting support center and a palliative care team in June 2009, and staffed them with multidisciplinary personnel.

[For a smooth introduction of psychotherapeutic treatment into palliative care--a flexible intervention in cooperation with other medical professionals].

When cancer patients and their families decide to face their disease and live their life together the way they want to live, and then have a spiritual crisis, regardless of whether patients are at home or in hospital, other medical professionals should voluntarily take the lead in supporting patients and their families. Such support will help them to regain their self-care ability quickly, and as a result, they will be able to expect a more comfortable life at home. For that purpose, it is important for a person in charge (an ideal person will be considered to be as flexible as possible instead of doing just his or her job) to improve his/her skills in advance, so that he or she can implement things timely and appropriately for an intervention.