Psycho-Oncology Division

Introduction
The Psycho-Oncology Division was re-constructed and then restarted in September 1995, together with the establishment of the Psycho-Oncology Division of the National Cancer Center Research Institute East (NCCRIE). One of the most important clinical activities of the Psycho-Oncology Division is the appropriate management of cancer patients social problems as well as their psychological distress. Furthermore, this division s aim is to alleviate distress of patients families and medical staff. Research activity is focused on studying the psychosocial influence of cancer on the quality of life of patients, their families, and medical staff.

Routine Activities
The Psycho-Oncology Division consists of one attending psychiatrist, two part-time psychiatrists and one clinical resident. The part-time psychiatrists are each available half-day per week. The division provides two major services; a clinic for outpatients and consultation for referred inpatients. The purpose of the psychiatric consultation is to assess and to deal appropriately with emotional distress and other psychological problems of cancer patients who are referred by attending physicians. Since 1999, the division has played an active role as a member of the palliative care team that established in the National Cancer Center Hospital to provide a comprehensive supportive care to patients and their families.
The characteristics of referred patients are shown in the Table. Psychiatric diagnosis is based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria. In 2001, 625 referrals were made for the psychiatric consultation, which had been increasing since the establishment of the Psycho-Oncology Division. The referrals included those from 17 cancer patients family members. More than 30 percent of them were outpatients. The most common psychiatric diagnosis was adjustment disorder (40.2%), followed by major depression (15.4%) and delirium (11.4%), while 12.8% of the referrals had no psychiatric diagnosis. Aggregation of these three common mental disorders; adjustment disorder, major depression and delirium accounted for two thirds of the psychological problems in the referrals. The most common cancer site in referred patients was leukemia (14.4%), followed by the lungs (11.8%) and the breast (9.3%).
Of these referred patients, 53.9% had recurrent and/or metastatic cancer. The most frequent reason for psychiatric consultation was psychiatric evaluation (55.5%), followed by patient s request (40.8%) and psychiatric history of non-psychotic disorders (25.3%). Of all the referred patients, 37.3 % had pain.
A conference on clinical and research activities is held every Thursday afternoon with the staff of the Psycho-Oncology Division, NCCRIE. At a part of the conference, problematic cases referred to the Psycho- Oncology Division are carefully discussed with the psychiatrists of the Psychiatry Division of the National Cancer Center Hospital East and National Shikoku Cancer Center Hospital. Ongoing and planning protocols are also discussed, and important international medical journals are reviewed together with the members of the Psycho-Oncology Division of NCCRIE. Additionally, the division members have attended a conference of the palliative care team every Friday morning and held weekly rounds with the member of the team at the afternoon.

Research Activities
We conducted a study on mental adjustment to first recurrence in patients with breast cancer. We investigated factors that are correlated with mental adjustment styles of fighting spirit or helplessness/ hopelessness in women with recurrent breast cancer. Fifty-five participants were interviewed and completed the National Cancer Center Hospital Annual Report Mental Adjustment to Cancer scale. Factors that correlated significantly with fighting spirit were performance status and history of major depression, while factors correlated significantly with helplessness/hopelessness were age, pain and history of major depression. There result of the study suggest that it is necessary to provide intervention for first recurrent breast cancer patients who have such biomedical factors, as young age, poor performance status, pain and history of major depression to help them to better cope with cancer.
We also conducted a study on fatigue in ambulatory patients with advanced lung cancer. The purpose of the study was to clarify fatigue prevalence and the factors correlated with fatigue, and to develop a novel screening method tailored for fatigue among patients with advanced lung cancer. One hundred fifty-seven patients completed two fatigue scales; Cancer Fatigue Scale (CFS) and Fatigue Numerical Scale (FNS) with a self-administered questionnaire asking whether fatigue had interfered with any daily activities. Fifty-nine percent of patients had experienced clinical fatigue. Logistic regression analysis demonstrated that symptoms of dyspnea on walking, appetite loss and depression were significant correlated factors. Both CFS and FNS were found to have sufficient sensitivity and specificity for use as a screening tool. The results of the study indicated that fatigue is a frequent and important symptom, which is associated with both physical and psychological distress in the patients with advanced lung cancer. The CFS and FNS were confirmed to have sufficient screening ability.
We are conducting studies of development of a simple screening method for major depression in patients with cancer, and development of the algorithm for the treatment of major depression in patients with advanced cancer. Because there is no tailored short-form screening method of major depression that is feasible in patients with cancer, and no guideline for medication of major depression in patients with advanced cancer developed to date.

T. NAKANO

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