Psychiatry Service
Introduction
The Psychiatry Service of the National Cancer Center Hospital East was established in July 1996. This Service has been designed not only to manage and alleviate the emotional distress due to cancer in patients and their families, but also to study the influence of psychosocial issues on patients' quality of life or survival.
Routine Activities
The Psychiatry Service consists of two part-time psychiatrists and one resident psychiatrist. The main clinical practice involves psychiatric consultation to assess and deal appropriately with the emotional distress and other psychological problems of cancer patients who are referred by attending physicians. The consultation data are shown in the Table. Psychiatric diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. In 1998, 236 cancer patients consulted the Psychiatry Service. Of these patients, 78.4% were inpatients. The most common psychiatric diagnoses were adjustment disorders (30.9%), delirium (21.2%) and major depression (16.1%). These three mental disorders accounted for approximately two-thirds of psychological problems in referred cancer patients. The most common cancer site was lung, followed by head and neck. More than 70% of referred patients had recurrent or metastatic cancer. The most common reasons for psychiatric consultation were psychiatric evaluation (26.7%), and depression (15.7%). Of all referred patients, 72.0% had pain.
The liaison rounds for newly referred inpatients are performed every Wednesday afternoon with the Psycho-oncology Division, National Cancer Center Research Institute East (NCCRIE). Before the rounds, difficult cases to assess or to deal with are also thoroughly discussed.
A conference on research activities is held every Thursday afternoon with the Psycho-oncology Division, NCCRIE. At the conference, planning protocols are discussed and important journals are reviewed by all members of the Psycho-oncology Division, NCCRIE, the Psychiatry Service, National Cancer Center Hospital East and the Psychiatry Division, National Cancer Center Hospital.
Research Activities
1. Screening for Psychological Distress in Japanese Cancer Patients
The purpose of this study is to develop a simple battery for psychological distress in Japanese cancer patients. One hundred twenty-eight cancer patients were interviewed and tested using the Hospital Anxiety and Depression Scale (HADS), and the Japanese version of HADS was shown to be a sensitive, valid and reliable tool for screening for major depression and adjustment disorders in Japanese cancer patients. Furthermore, it has been suggested that this scale can be used for early detection of patient psychological distress, which may be followed by psychiatric interventions.
2. Predictive Factors for Psychological Distress in Ambulatory Lung Cancer Patients
The purpose of this study is to investigate potential predictors of psychological distress among ambulatory lung cancer patients. Evaluable data were obtained from 87 patients, and multiple regression analysis indicated that female gender, living alone, no children in the role of confidant, nurses as confidants and helplessness/hopelessness as coping style were predictive for psychological distress. It has been suggested that these results may later be useful in developing interventions to facilitate a patient's adjustment to lung cancer.
3. Ongoing Protocol Study
Studies on fatigue in cancer patients in collaboration with the Palliative Care Service, group intervention for patients with high-risk breast cancer, and relationship between posttraumatic stress disorder symptoms and memory function in breast cancer survivors are now ongoing.
Statistics
| No. (%) | |
| Gender (male/female) | 118 (50.0) /118 (50.0) |
| Inpatient/outpatient | 185 (78.4) /51 (21.6) |
| Cancer site | |
| Lung | 74 (32.9) |
| Head and neck | 38 (16.9) |
| Breast | 35 (15.6) |
| Pancreas | 14 (6.2) |
| Stomach | 13 (5.8) |
| Stage recurrent or metastatic | 167 (73.3) |
| PS 0/1,2/3,4 | 41 (17.5) /115 (48.9) /79 (33.6) |
| Pain presence | 164 (72.0) |
| Disclosure of cancer diagnosis | |
| Disclosed | 228 (97.9) |
| Reason for the consultation (multiple choice) | |
| Psychiatric evaluation | 63 (26.7) |
| Depression | 37 (15.7) |
| Sleep problems | 33 (14.0) |
| Suicidal risk/attempt evaluation | 28 (11.9) |
| Anxiety/fear | 28 (11.9) |
| Psychiatric diagnosis | |
| Adjustment disorders | 73 (30.9) |
| Anxious mood | 35 (14.8) |
| Mixed emotion | 25 (10.6) |
| Depressive mood | 12 (5.1) |
| Delirium | 50 (21.2) |
| Major depression | 38 (16.1) |
| Others | 53 (22.5) |
| No diagnosis | 22 (9.3) |
(Y. Uchitomi)
