Psycho-Oncology Division
Introduction
The purpose of the Psycho-Oncology Division is to develop mind-centered interventions to restore, maintain, and improve the quality of life of the patients and their families who face the life-threatening illness, cancer. The Division has focused on determining the mechanism of the relationship between cancer and the mind through a combination of neuropsychiatric, psychosocial, and behavioral sciences.
Research and Development of Interventions for Depression
The Division developed a novel multifaceted psychosocial intervention program that involves screening for psychological distress and provision of comprehensive support including individually tailored psychotherapy and pharmacotherapy by mental health professionals (100). The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing psychological distress that is experienced by patients with recurrent breast cancer. The subjects who participated in the 3-month intervention program completed a psychiatric diagnostic interview and several self-reported questionnaires regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before intervention (T1), immediately after intervention (T2), and at 3 months after intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85% and 86%, respectively. The proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15); however, the proportion of psychiatric disorders at T3 (7.7%) had significantly decreased as compared to that at T1 (p = 0.005). The novel intervention program is feasible and is a promising strategy for reducing clinically manifesting psychological distress; further controlled studies on this program are warranted.
Little is known regarding its susceptibility to treatment, particularly when patients reach very close to the end of life. This study was conducted to evaluate the response rate of end-of-life depression to psychiatric intervention and to assess the feasibility of conventional evidence-based pharmacological therapy for depression (101). Of the 20 patients, 7 were responders but no response was achieved when the survival time was <3 weeks. These results suggested that patient survival time largely determines the susceptibility to psychiatric treatment, and it is difficult to achieve a response in patients whose survival time was less than approximately 1 month.
Using F18-fluorodeoxyglucose (F18-FDG) positron emission tomography (PET), the regional cerebral glucose metabolism was examined in antidepressant-naïve pancreatic cancer patients who had a depressive episode after cancer diagnosis and before cancer treatment (102). Of the 21 pancreatic cancer patients, 6 were diagnosed with a depressive episode. A significantly higher glucose metabolism was found in the subgenual anterior cingulate cortex (sACC) (uncorrected p = 0.002) in depressed patients. The higher metabolism in the sACC may be associated with the pathophysiology of secondary depressive episodes in patients following the diagnosis of pancreatic cancer.
Research and Development of Interventions for QOL improvement and Refractory Symptoms
To understand patient preferences regarding the disclosure of bad news is important, since the bad news of cancer diagnosis is one of the most distressing events in life. The aim of this study was to preferences of cancer patients when receiving the bad news (103). A survey and descriptive analysis of 529 Japanese cancer outpatients revealed that >90% of the patients strongly preferred to discuss their current medical condition and treatment options with their physician and wanted their physicians to take the feelings of their family into consideration as well. Half of the patients preferred to receive information regarding their life expectancy, while 30% preferred not to receive it. Multiple regression analyses indicated that the preferences that showed interindividual variations were associated with the level of education and the mental adjustment to cancer scores. A factor analysis revealed 4 preference factors: method of disclosure of the bad news, provision of emotional support, provision of additional information, and the clinical setting. These 4 factors had good internal consistency reliability (Cronbach’s alpha = 0.93–0.77). Provision of emotional support, including consideration for the patient’s family and understanding of an individual’s communication preferences, may be useful for promoting patient-physician communication.
The communication preferences of Japanese cancer patients when receiving bad news differ somewhat from their American counterparts. Japanese physicians should encourage patients to ask questions and should consider their demographic (e.g. gender), medical (disease status), and psychosocial characteristics (fighting spirit and anxious preoccupation) of patients when delivering bad news (104).
The mechanisms of refractory symptoms remain unclear (105-118). Cognitive impairment in breast cancer survivors might be associated with neural damage due to adjuvant chemotherapy. The current study explored the regional brain volume differences between breast cancer survivors exposed to adjuvant chemotherapy (C+) and those unexposed to it (C–) (119, 120). High-resolution 1.5-T brain magnetic resonance imaging (MRI) databases of breast cancer survivors and healthy controls were used. The brain images were clarify descriptively the communication preprocessed for optimal voxel-based orphometry. The gray matter and white matter volumes were compared between the C+ and the C– groups using MRI scans obtained within 1 year (the 1-year study; n = 51 and n = 55, respectively) or 3 years after cancer surgery (the 3-year study; n = 73 and n = 59, respectively). As exploratory analyses, correlation analyses were performed between the indices of the Wechsler Memory Scale-Revised and the regional brain volume when the volumes were significantly smaller. As a reference, the MRI scans of cancer survivors were compared with those of the healthy controls (n = 55 and n = 37 for the 1- and 3-year study, respectively). In the 1-year study, the C+ patients had a smaller gray matter and white matter volume including the prefrontal, parahippocampal, and cingulate gyri and the precuneus. However, no difference was observed in the brain volumes in the 3-year study. The volumes of the prefrontal and parahippocampal gyri and the precuneus significantly correlated with the indices of attention/concentration and/or visual memory. Comparisons with healthy controls did not show any significant differences. Adjuvant chemotherapy might have an influence on brain structure, which may account for the previously observed cognitive impairments.
● Y. Uchitomi ●
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