20. Psychooncology Division
Established in September 1995, the Psychooncology Division has focused in two dimensions: (1) the psychosocial impact of cancer on the quality of life of the patient, family and staff; (2) the role that psychological and behavioral variables may have in cancer risk and survival. The latter area is also considered psycho-neuroimmunology, addressing the impact of mood states on the immune and endocrine systems that may contribute to cancer risk.
Diagnosing Depression in Cancer Patients
Psychiatric epidemiological studies revealed that 20-30% of hospitalized patients with cancer were moderately or severely depressed. However, only approximately 2% are referred for psychiatric consultation. One of several important factors that interfere with appropriate referrals is a difference between the perception of cancer patients and that of their physicians regarding the patient's psychological symptoms, especially depression. Depression is frequently underestimated and undertreated because the diagnosis of depression is frequently clouded by neurovegetative symptoms (e.g. fatigue, insomnia, loss of appetite, psychomotor retardation and diminished ability to concentrate) that may be secondary to either the cancer or depression. It is important to diagnose depression in cancer patients appropriately, since depression is responsive to brief supportive psychotherapy and psychotropic medication, and since diminished immune function has been observed in patients with depression. As pathological research on depression develops, many researchers are challenged to find possible biological markers as diagnostic adjuncts. The markers are 1) endocrine markers: based on alteration of the hypothalamo-pituitary-adrenal axis, or the hypothalamo-pituitary-thyroid axis, or other hormones; 2) neurotransmitters and their signaling systems: mono-amines such as serotonin (5-HT) and noradrenalin (NA), the densities and functions of their receptors, and second messengers; 3) immune markers: counts of WBC, lymphocytes, etc., and cytokines. As well as the alterations of neurotransmitters such as 5-HT and NA, studies on dysfunction of intracellular signaling systems have been focused on the pathophysiology of the depressive disorders. Many studies have indicated the abnormality of 5-HT-2 receptor-mediated signaling systems in these disorders.
First, prevalence studies using the structured diagnostic interview will be carried out to estimate psychiatric comorbidity of depression in cancer patients.
Second, diagnosing depression with possible biological markers such as serotonin-induced calcium mobilization in platelets and mitogen-stimulated lymphocyte interleukin 1-beta production will be attempted. Appropriate treatment of depression in these patients would improve their mood states and may improve immune function and survival time.
Psychosocial Interventions for Cancer
As increasing numbers of patients with cancer survive longer, psychosocial intervention to help cancer patients deal with diagnosis and treatment has become more important. Although the variety of psychosocial interventions has increased, most interventions consist of three parts: 1) educational techniques to understand cancer and its treatment; 2) behavioral training including progressive muscle relaxation techniques; 3) group therapy with mutual support. The primary goals of the psychosocial interventions in cancer patients are to improve the patients' quality of life; to decrease the feeling of alienation by encouraging the patient to talking with other cancer patients in a similar situation, to lessen the feeling of isolation, helplessness and hopelessness, to reduce fear and anxiety about treatments and to assist in clarifying misperceptions and misinformation. Moreover, the second goal is to have a beneficial effect on cancer risk and survival presumably by enhancing effective coping with cancer (e.g. fighting spirit, active behavioral strategies) and reducing distress as well as improving life style and compliance with medical regimens. Group psychosocial intervention for persons with high risk as well as early and advanced cancer will be carried out.
Symptom Management
Fatigue is frequently observed in patients with advanced cancer as well as in depression. Although the use of corticosteroids is thought to be benefical for those cancer patients and sometimes cause depression, its mechanism is still unknown. Since altered immunological responses are observed in depression, the pathophysiology of fatigue syndrome will be investigated in cancer patients with/without depression. Furthermore, psycopharmacological intervention with antidepressants and/or immuno-modulators may have beneficial effects in patients with depression and /or fatigue.
List of papers from this division is not available
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