Table of Contents
Routine Activities
Palliative care service
Consultations with a total of 312 patients (168 males, 144 females) were held at the palliative care clinic from April 1996 to March 1997. According to a survey of these patients, 142 (46%) were referred from other clinical departments of NCCHE, 53 (17%) from the National Cancer Center Hospital, Tokyo, and 117 (37%) from medical institutions other than the above two. At the time of the first visit, 87% of the patients were already aware of their illness and understood the diagnosis. Only 13% were unaware. And of the 312 patients, 136 (44%) had been previously treated with either surgery, radiation therapy or chemotherapy, 98 (31%) with any two of the above three, and 18 (6%) with all three. In other words, 52 (17%) were untreated and the remaining eight unsure. Of the 312 patients, after the first consultation, 170 (55%) had been registered on the outpatient list, 75 (24%) put on the waiting list for admission, and 67 (21%) were unregistered. About 80% of the former two (197/245) were actually admitted to the PCU after consultation at the clinic.
During the year 1997, on the other hand, a total of 281 patients were treated at the PCU. Annual changes in the number of inpatients in the PCU in the past three years are shown in the first table.
Psychiatry Service
From January to December 1997, 206 patients (106 males, 100 females) used the Psychiatric Services. As with their primary illness, lung cancer was the most frequent (52 patients: 25%), followed by head and neck (44 patients: 21%) and breast cancers (33 patients: 16%). Most of the cases were in the advanced stage, i.e. 30 (15%) were in Stage III, 60 (29%) in Stage IV and 65 (32%) with recurrent disease. The commonest (73%) reason for a patientÕs visit was pain, i.e., mild pain in 71 cases (34%), moderate in 55 cases (27%) and severe and/or serious in 23 cases (12%). Only the remaining 57 patients (27%) were not in pain.
Psychiatric diagnoses of these patients are shown in the second Table. In comparison with those in the last year, adjustment disorders rose from 16% to 41%, major depression slightly decreased from 23% to 18%, and delirium also decreased from 28% to 11%. These results indicate a tendency that patients easily consult with the Psychiatric Services though their mental symptoms are relatively mild.
New Developments
In 1997, we undertook two clinical research projects for the treatment of PCU patients. One was a phase II study on the procedure of administering morphine to alleviate dyspnea. Forty-eight patients who complained of dyspnea were enrolled in this study. As a result, a high efficacy rate of 76% was obtained, although no particular adverse drug reactions which prevented the morphine administration were observed. The other project was a phase I/II study of Octreotide for abating nausea and vomiting caused by an obstructive condition of the gastrointestinal tract. Up to the present, seven patients have entered into this study, which is still underway.
Three projects were started at the Psychiatric Services. The first one is a study on major depression in cancer patients, carried out from not only a psycho-social but also a biological approach. The second is a study on malaise and fatigue in cancer patients. This is a cooperative study with the Palliative Care Service, and 41 patients were registered in this study from October to December 1997. The third is a study on group therapy for patients with breast cancer. This was started for the purpose of treating patients who underwent mastectomy and have a high risk of recurrence. These three studies are still underway.
Statistics
| 1995 | 1996 | 1997 | |
| Hospitalized | 272 | 294 | 281 |
| Discharged | 266 | 235 | 263 |
| Dead | 188 | 184 | 199 |
| Alive | 78 | 51 | 64 |
| Diagnosis | No. of pts |
| Adjustment disorder | 85 (41%) |
| Major depression | 36 (18%) |
| Delirium | 22 (11%) |
| Anxiety disorder | 5 (2%) |
| Psychosis | 4 (2%) |
| Alcoholism | 3 (2%) |
| Others | 26 (13%) |
| No diagnosis | 25 (12%) |
(Y. Shima, Y. Uchitomi)