The objective of the Psycho-Oncology Division is to develop mind-centered interventions to restore, maintain, and improve the quality of life of patients and their families who face life-threatening illnesses such as cancer. The Division has focused its research activities on determining the mechanism underlying the relationship between cancer and the mind through a combination of neuropsychiatric, psychosocial, and behavioral sciences.
The Division developed a pharmacological treatment algorithm in a previous study for major depressive disorder in patients with advanced cancer. The study aimed to describe the applicability and dropout of the algorithm (142, 143). Psychiatrists treated major depressive disorder in advanced cancer patients on the basis of the algorithm. The algorithm was applied to 54 of 59 patients (applicability rate, 92%). On the other hand, the reasons for the non-application of the algorithm were (1) the need to add benzodiazepine to an antidepressant in 4 patients and (2) the need to use alprazolam despite moderate depression in order to obtain a rapid onset of action and reduce anxiety in a patient with short prognosis. Nineteen of the 55 patients dropped out within one week of treatment initiation based on the algorithm, with delirium being the most frequent reason for the dropping out. The applicability rate of the algorithm was high; however, several problems were identified, including those related to the combination of antidepressants and benzodiazepines, pharmacological treatment of depression in patients with short prognosis, and delirium due to antidepressants.
Moreover, the Division also developed the nurse-assisted screening and psychiatric referral program (NASPRP). A high refusal rate, however, proved to be a problem even though referral was recommended to all positively screened patients by nurses. The NASPRP was therefore modified so that nurses could judge the final recommendation for psychiatric referral (144). A retrospective analysis of the Chart review showed that the annual referral rate of the modified NASPRP terms was 4.4%. This rate was not significantly higher than the usual care period (3.0%), and was significantly lower than the NASPRP period (11.5%). Thus, the modified NASPRP may not completely facilitate the psychiatric treatment of depressive patients and another approach is therefore needed.
Although the mechanisms of refractory symptoms remain unclear (145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 159, 160), it is also necessary to clarify factors correlated with fatigue in terminally ill cancer patients. A consecutive sample of cancer patients newly registered in the Palliative Care Unit (PCU) was assessed on three occasions (155): (1) at the second visit to the outpatient clinic of the PCU (Time 1), (2) three weeks after the Time 1 session over the telephone (Time 2), and (3) on admission to the PCU (Time 3). The patients’ fatigue and a broad range of biopsychosocial factors were assessed using validated questionnaires, structured interviews, and medical record reviews at Times 1 and 3. Fatigue was the only factor assessed at Time 2. Two hundred patients participated in the Time 1 session, and 129 and 73 were followed in the Time 2 and Time 3 sessions, respectively. Greater fatigue at Time 1 was significantly correlated with psychological distress, lower Karnofsky Performance Status (PS) score, dyspnea, and appetite loss (adjusted coefficients of determination [R2] = 0.49). greater fatigue at time 2 was significantly correlated with psychological distress, lower karnofsky ps score and fatigue at time 1 (adjusted r2 = 0.51). greater fatigue at Time 3 was significantly correlated with changes for the worse in psychological distress, Karnofsky PS score, and dyspnea severity during the period between Times 1 and 3, after adjusting for Time 1 fatigue (adjusted R2 = 0.54). the results indicate that fatigue in terminally ill cancer patients is determined by both physical and psychological factors. it may therefore be important to include psychological intervention in the multidimensional management of fatigue in terminally ill cancer patients, in addition to physical and nursing interventions.
Furthermore, the potential association between fatigue and plasma interleukin-6 (IL-6) was examined in 46 terminally ill cancer patients (median survival: 64.5 days) who received neither steroids nor nonsteroidal anti-inflammatory drugs (156). Fatigue was evaluated using the Cancer Fatigue Scale (CFS), which consists of multiple dimensions of fatigue, such as Physical, Affective, and Cognitive subscales. Plasma IL-6 levels were measured using enzyme-linked immunosorbent assay and were compared between patients with and without ‘clinical fatigue’ as defined by the total CFS score. Additionally, the associations between each of the CFS scores and IL-6 levels were examined. Results showed that the IL-6 level in patients with clinical fatigue (n = 27 [59%]; mean, sd, median, and range: 37.1, 46.4, 17.1, and 3.7-182.5 pg/ml, respectively) was significantly higher than that in patients without clinical fatigue (n = 19 [41%]; mean, sd, median, range: 14.3, 12.2, 8.0, and 2.8-45.0 pg/ml, respectively) (P = 0.02). the il-6 level was significantly correlated with the physical subscale score (r = 0.35, p = 0.02), but not with other subscale scores. our investigation thus showed that il-6 may play a role in fatigue, especially in the physical dimension, in terminally ill cancer patients. The results obtained in this study provide valuable information for the development of a new treatment strategy for cancer fatigue in terminally ill cancer patients.
Moreover, magnetic resonance imaging volumetric analyses of hippocampi and amygdalae indicated that intrusions, not PTSD diagnosis, might be associated with hippocampal volume.
Previous studies have suggested that psychosocial factors are associated with survival from lung cancer; however, their association is not conclusive. In this regard, the association between marital status and survival in Japanese patients with non-small cell lung cancer (NSCLC) was prospectively investigated (157). The multivariable adjusted hazard ratio of male widowed patients versus male married patients was 1.7 (95% confidence interval = 1.2-2.5, p = 0.005), suggesting that male widowed patients with NSCLC have a higher mortality rate.
Furthermore, a prospective cohort study database in Japan was used to investigate associations between negative psychological aspects and cancer survival. Between July 1999 and July 2004, a total of 1178 lung cancer patients were enrolled. The obtained data supported the hypothesis that the association between helplessness/hopelessness and depression and the risk of mortality among lung cancer patients was largely confounded by clinical state variables including clinical stage, PS, and clinical symptoms (158).
● Y. Uchitomi ●
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