title: [Palliative home care of a breast cancer patient with esophageal metastasis after the operation of gastric fistula and tracheotomy--a case study].
abstract: A 66-year-old woman felt dysphagia gradually seven years after an operation of breast cancer. We diagnosed her with esophageal metastasis of the breast cancer, and carried out irradiation and outpatient chemotherapy. Because her general condition became worse after the treatment for about four years, we performed an operation of gastric fistula and tracheotomy to manage her nutrition and of an accidental swallowing. Although the patient and her family resisted a discharge from hospital due to the progressive nature of her illness and change in physical surroundings, she was eventually switched to take a homecare medical treatment with the support of a team care approach. The main purposes of the homecare treatment were to manage gastric fistula including the administration of anti-cancer drugs, cervicobrachial pain control and tracheal cannula exchange. Though she was mentally stable and got along well with the family during the home stay, she was hospitalized again two months after the homecare treatment because of aggravated symptoms and the family's fatigue. We respected the value of her quality of life and gave careful considerations to support her during the entire period of re-hospitalization. She gently died two months after re-hospitalization. We considered that this palliative home care could be realized with the palliative team care, nursing intervention visit and family support.
authors.affiliation: Dept. of Surgery, Shizuoka Red Cross Hospital.
authors.forename: Koh
authors.initials: K
authors.lastname: Shiraishi
authors.forename: Akemi
authors.initials: A
authors.lastname: Wakita
authors.forename: Izumi
authors.initials: I
authors.lastname: Ishigami
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Tomita
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Takamori
authors.initials: T
authors.lastname: Nakayama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Inaba
authors.forename: Takao
authors.initials: T
authors.lastname: Nishiumi
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Mori
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Isobe
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000451:nursing / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000451:nursing / Q000556:secondary*; D004940:Esophageal Stenosis / Q000628:therapy; D005260:Female; D005774:Gastrostomy; D018575:Home Care Services, Hospital-Based; D006801:Humans; D010166:Palliative Care; D010348:Patient Care Team; D014140:Tracheotomy