Psychiatry Service
Introduction
The Psychiatry Division of the National Cancer Center Hospital East was established in July 1996. This Division has been designed not only to manage and alleviate the emotional distress due to cancer among patients, their families, and oncology staff, but also to study the influence of psychosocial issues on patients' quality of life or survival.
Routine Activities
The Psychiatry
Division consists of three adjunct and two part-time psychiatrists and one
clinical resident. The main clinical practice involves psychiatric consultation
to assess and deal appro-priately 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 DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition)
criteria. In 2000, total of 300 referrals were made for the psychiatric consultation.
These referrals included 9 cancer patients' family members and 5 oncology
staff members. Among them 71.3% were inpatients; The most common psychiatric
diagnosis was major depression (27.3%) followed by adjustment disorders (26.3%)
and delirium (18.0%). These three mental disorders accounted for more than
two thirds of psychological problems in psychiatric consulation. The most
common cancer site was lung, and the next was breast. More than 60% of the
refferals had recurrent or metastatic cancer. The most common reason for psychiatric
consultation was psychiatric evaluation (35.3%), followed by depression (24.0%)
and anxiety/fear (18.0%). Of all the refferals, more than half patients had
pain.
The liaison
rounds for the newly referred inpatients are performed every Wednesday afternoon
with the staff from the Psycho-Oncology Division, National Cancer Center Research
Institute East. Before the rounds, difficult cases to assess or deal with
are also discussed carefully.
A conference on research activities is held every Tuesday evening. At the conference, planning protocols are discussed and important journals are reviewed by all the members of our division staff and all members of both the Psycho-Oncology Division, National Cancer Center Research Institute East and the Psychiatry Division, National Cancer Center Hospital.
New Developments
1. Prevalence and predictive factors for
psycho-logical distress in patients with newly diagnosed head and neck cancer
The purpose of this study is to investigate prevalence of psychological distress (adjustment disorders or major depression) and predictive factors for these distress in patients with newly diagnosed head and neck cancer. Of consecutive 107 subjects, 16.8% had an adjustment disorder or major depression. In addition, 33.6 %, 6.5%, and 32.7% met criteria for alcohol dependence, alcohol abuse, and nicotine dependence, respectively. Just 33.6% of the subjects did not suffer from any psychiatric disorders. Multivariate logistic regression analysis revealed that having advanced stage cancer and living alone were significantly associated with having psychological distress. The result suggested that substance dependence is a predominant psychiatric disorder in head and neck cancer patients and that patients who have advanced disease or live alone should be assessed so that psychological distress can be detected and managed.
2. Depression after successful treatment
for nonsmall cell lung carcinoma
The purpose of this study is to clarify the prevalence and correlated factors of depression in nonsmall cell lung cancer patients after successful surgical treatment. Of 223 consecutive patients, 14.8% met the criteria for major or minor depression during the 3 months after surgery. One-month prevalence of depression at 1, 2, and 3 months after surgery were 9.0%, 9.4%, and 5.8% respectively. The results of multivariate analysis revealed that only satisfaction with confidants before surgery was significantly associated with depression during the 3 months after surgery. These results suggest that depression in not rare after successful treatment for nonsmall cell lung cancer and that social support may play an important role for patients with depression after successful treatment.
3. Development of the Cancer Fatigue Scale
The Cancer Fatigue Scale (CFS) was developed to assess fatigue that is a prevalent and distressing symptom in cancer patients. After factor analysis, CFS composed of 3 subscales (physical fatigue, affective fatigue, and cognitive fatigue) was developed. Validity and reliability of CFS were confirmed among 307 cancer patients. The obtained findings indicate that the CFS is a brief, valid, and feasible measure of fatigue for use with cancer patients.
4. Ongoing protocol study
Studies on fatigue in terminally ill cancer patients and on relationship between posttraumatic stress disorder (PTSD) symptoms, hippocampal volume, and memory function in breast cancer survivors are now ongoing.
|
Psychiatric Consultation Data
(N=300, january - december, 2000) |
|
|
No.(%) |
|
|
Age (Mean+SD, yr) |
58+12 (median; 60, range; 21-85
yr.) |
|
Gender (male / female) |
165 (55.0)/ 135 (45.0) |
|
Inpatient /outpatient |
214 (71.3)/ 86 (28.7) |
|
Cancer site |
|
|
Lung |
68 (22.7) |
|
Breast |
41 (13.7) |
|
Head and Neck |
36 (12.0) |
|
Malignant lymphoma |
29 (9.7) |
|
Colon |
22 (7.3) |
|
Stage Recurrence or metastatic |
192 (64.0) |
|
PS (0/1,2/3,4) |
96 (32.0) / 105 (35.0) / 91 (30.3) |
|
Pain (presence) |
168 (56.1) |
|
Disclosure of cancer diagnosis |
|
|
(disclosed) |
228 (97.9) |
|
Reasons for the consultation (multiple
choice) |
|
|
Psychiatric evaluation |
106 (35.3) |
|
Depression |
72 (24.0) |
|
Anxiety/fear |
54 (18.0) |
|
Sleep disorders |
39 (13.0) |
|
Patient request |
37 (12.3) |
|
Psychiatric diagnosis |
|
|
Major depression |
82 (27.3) |
|
Adjustment disorders |
79 (26.3) |
|
Anxious mood |
34 (11.3) |
|
Mixed emotion |
21 (7.0) |
|
Depressive
mood |
20 (6.7) |
|
Delirium |
54 (18.0) |
|
Others |
60 (20.0) |
|
No diagnosis |
25 (8.3) |
(Y. UCHITOMI)
