20. Psychooncology Division
Established in September 1995, the Psychooncology Division of the Research Institute, East has focused on two aspects of cancer; (1) psychosocial impacts of cancer on the quality of life of the cancer patient, family and staff; (2) the role that psychological and behavioral variables may have in cancer risk and survival.
Psychiatric Epidemiology in Cancer Patients
Psychiatric prevalence studies revealed that approximately half of patients with all stages of cancer showed distress, with depression being the most common manifestation. Although the stage of cancer is one factor influencing the nature and incidence of psychiatric disorders, no study has demonstrated the extensive range of psychiatric disorders in terminally ill cancer patients. Ninety-three terminally ill cancer patients, admitted to the Palliative Care Unit, were systematically assessed using the Mini-Mental State Examination (MMSE) and Structured Clinical Interview for DSM-III-R (SCID) within 1 week of admission.(196) Of this sample population, 53.7% met the DSM-III-R criteria for a psychiatric disorder and 42% had a cognitive impairment. Delirium was seen in 26 (28.0%) patients, dementia in 10 (10.7%), adjustment disorders in 7 (7.5%), amnestic disorder and major depression in 3 (3.2%), and a generalized anxiety disorder in 1 (1.1%). This preliminary investigation of the prevalence of psychiatric disorders in terminally ill cancer patients showed that more than half of patients met the criteria for a DSM-III-R psychiatric disorder, with the most common type of psychiatric disturbance in this population being delirium. Further prospective trials will be of critical importance in establishing treatments aimed at promoting the well-being of patients with terminal illnesses.
Symptom Management
Delirium, as well as depression, is frequently observed in patients with advanced cancer. Although the use of haloperidol, a selective dopamine blocker, is thought to be beneficial for such cancer patients, it can cause oversedation in some cases, and there are no universally accepted guidelines for its usage. The usefulness, in managing delirium, of a haloperidol treatment regimen was assessed in 10 delirious cancer patients.(197) The results of this preliminary study suggest that, in the management of delirium, appropriate usage of haloperidol on the first day is important as the dosage is impacted thereafter.
Although fatigue is also frequently observed in patients with advanced cancer as well as depression, the underlying mechanism remains unknown. The pathophysiology of fatigue syndrome will be multidimensionally investigated in cancer patients with/without depression.
Diagnosing Depression in Cancer Patients
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 cancer or depression. It is important to diagnose depression in cancer patients appropriately, since depression may diminish the patientŐs competence. Since many studies have indicated an abnormality involving 5-HT-2A receptor-mediated signaling systems in affective disorders, 5-HT-2A receptor-mediated calcium mobilization has been investigated in rat glioma cells.(198-202) Diagnosing depression with serotonin-induced calcium mobilization in human platelets will be a future research challenge.
Psychosocial and Behavioral
Factors in the Development
of Cancer
The need for a large variety of psychosocial interventions has increased along with rising numbers of cancer patients with prolonged survival. The intervention consisted of three parts; 1) educational techniques aimed at understanding cancer and its treatment; 2) behavioral training including progressive muscle relaxation techniques; 3) group therapy with mutual support. The primary goals of psychosocial interventions designed for cancer patients are beneficial effects on the quality of life; to decrease the feeling of alienation by talking with other cancer patients in a similar situation, to lessen feelings of isolation, helplessness and hopelessness, to reduce fear and anxiety regarding treatments and to assist in clarifying misperceptions and misinformation. Since there is a weak link between psychosocial and behavioral factors and the subsequent development of cancer, the second goal is to exert beneficial effects on cancer risk and survival presumably by enhancing effective cancer coping skills (e.g. a fighting spirit, active behavioral strategies) and reducing affective distress as well as improving life style and compliance with medical regimens. Group psychosocial intervention for persons at high risk, as well as those with early and advanced cancer, will be carried out.
List of papers from this division
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