{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:24:32Z","timestamp":1787927072889,"version":"build-2784847793"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individualized opioid titration is recommended for symptom management in patients with advanced cancer, but prospective data from home hospice care remain limited. We evaluated individualized opioid titration in terminally ill cancer patients receiving physician-led home hospice care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational study included 501 consecutive terminally ill cancer patients who died under the care of a home hospice clinic between January 2020 and December 2025. Opioids were prescribed for cancer-related pain and other opioid-responsive symptoms. When oral administration became difficult, continuous subcutaneous infusion with patient-controlled analgesia (PCA) was used. Final opioid type, route of administration, oral morphine equivalent daily dose (MEDD), and ketamine use were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Opioids were administered to 490 patients (97.8%). Continuous subcutaneous infusion was the final route in 437 patients (89.2%). Morphine was the most frequently prescribed opioid (70.4%), followed by hydromorphone (22.2%) and oxycodone (7.1%). Final MEDDs ranged from 10 to 6000\u00a0mg\/day, demonstrating substantial interindividual variability. Patients aged \u226464\u00a0years required significantly higher MEDDs than those aged \u226565\u00a0years (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), whereas opioid requirements did not differ significantly according to primary cancer site (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.103). Ketamine was required in only 11 patients (2.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Terminally ill cancer patients receiving home hospice care showed marked interindividual variability in opioid requirements. These findings support repeated bedside assessment and individualized opioid titration rather than predetermined dose limits or primary cancer site as the cornerstone of patient-centered symptom management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261483178","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:52:21Z","timestamp":1787626341000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized Opioid Titration for Complex Symptom Management in Terminally Ill Cancer Patients Receiving Home Hospice Care: A Prospective Cohort Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8628-5451","authenticated-orcid":false,"given":"Kunihiko","family":"Watanabe","sequence":"first","affiliation":[{"name":"Home Hospice, Tochigi, Japan"},{"name":"Dokkyo Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumi","family":"Tochimura","sequence":"additional","affiliation":[{"name":"Visiting Nurse Venus Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Visiting Nurse Venus Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukie","family":"Kushima","sequence":"additional","affiliation":[{"name":"Hinata Visiting Nursing Station, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Kushima","sequence":"additional","affiliation":[{"name":"Hinata Visiting Nursing Station, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kamiyama","sequence":"additional","affiliation":[{"name":"Home Hospice, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akemi","family":"Hemmi","sequence":"additional","affiliation":[{"name":"Visiting Nurse Venus Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.2194"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2015.12.011"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311406577"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07514-4"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08710-0"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-025-09286-z"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdi922"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.02198"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy152"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.04.035"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19931201)72:11 <3393::AID-CNCR2820721606>3.0.CO;2-O"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1D395"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(99)00036-6"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-020-00681-3"},{"key":"e_1_3_6_16_2","volume-title":"Palliative care formulary","author":"Twycross R","year":"2017","unstructured":"Twycross R, Wilcock A, Howard P. Palliative care formulary. 5th ed. Nottingham: palliativedrugs.com Ltd; 2017, Japanese 2nd ed. Tokyo: Igaku Shoin.","edition":"5"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216310392102"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216310387962"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311406313"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(98)00144-4"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909112454325"},{"key":"e_1_3_6_22_2","first-page":"555","article-title":"Ketamine protocol for palliative care in cancer patients with refractory pain","volume":"6","author":"Loveday BA","year":"2015","unstructured":"Loveday BA, Sindt J. Ketamine protocol for palliative care in cancer patients with refractory pain. 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