Psycho-Oncology Division

20. Psycho-Oncology Division

　Established in September 1995, the Psycho-Oncology Division of the Research Institute East has focused on two aspects of cancer; (1) the psychosocial impacts of cancer on the quality of life of the patient, family and staff, and (2) the role that psychosocial and behavioral variables may have in cancer risk and survival.
Psychiatric Epidemiology in Cancer Patients

　Psychiatric prevalence studies in Western countries has revealed that approximately half of patients with all stages of cancer showed distress, with depression being the most common manifestation. Why depression? The frequently observed depression in cancer patients seems to be related to truth-telling practice in cancer care^(254,255) (e.g. disclosure of the diagnosis, recurrence, genetic high-risk).⁽²⁵⁶⁾ Since a few studies have demonstrated the extensive range of psychiatric disorders in patients with different clinical courses of cancer, patients with early, advanced and recurrent cancer are now systematically assessed using SCID. The preliminary results of these prevalence studies has shown that major depression and adjustment disorder with depressive mood were most common in Japanese cancer patients.^(257,258)
　Four hundred fifty-five ambulatory cancer patients were systemically assessed using Mental Adjustment to Cancer Scale.⁽²⁵⁹⁾ This survey revealed that positive coping to cancer, namely Fighting Spirit, was negatively correlated with depressive mood and that support from physician and satisfaction with social support predicted Fighting Spirit.
Diagnosing Depression in Cancer Patients

　Depression is frequently under-estimated and undertreated even in advanced cancer 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 symptomatic cancer, cancer treatment or depression. It is important to diagnose depression in cancer patients appropriately, since depression may diminish the patientﾕs competence, especially terminally ill cancer patients with a desire for death. Furthermore, 5-HT-_2A receptor-mediated calcium mobilization has been investigated in rat glioma cells.^(260-263) Diagnosing depression with serotonin-induced calcium mobilization in platelets of cancer patients with/without depression is now ongoing,⁽²⁵⁷⁾ since many studies have indicated an abnormality involving 5-HT-2A receptor-mediated signaling systems in affective disorders.
　Using the validated Japanese version of the Hospital Anxiety and Depression Scale, an optimal cut-off point for screening for adjustment disorder and major depression was determined as 10/11 whereas that for major depression was 19/20.⁽²⁶⁴⁾
Symptom Management

　Depression is frequently observed in patients with all stages of cancer. Although the use of antidepressants is thought to be beneficial for cancer patients, it is often not possible to use psychotropics due to adverse effects of oversedation, rarely neuroleptic malignant syndrome,⁽²⁶⁵⁾ gastrointestinal obstruction and the nature of its slow effects. Furthermore, there are no universally accepted guidelines for its usage in cancer patients. An algorithm for the psychopharmacological treatment of depression in advanced cancer patients has been developed.⁽²⁵⁷⁾
　Although fatigue is also frequently observed in patients with depression as well as advanced cancer, its mechanism is still unknown. Cancer fatigue must be studied both physically and psychosocially in cancer patients with/without depression. To investigate the pathophysiology of fatigue syndrome and establish a treatment for fatigue in cancer patients, the development of appropriate instruments to assess the symptoms of fatigue in cancer patients are now in progress.
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 surviving for longer periods. The primary goals of psychosocial interventions designed for cancer patients are improved quality of life; to decrease the feeling of alienation by talking with other cancer patients in a similar situation, to lessen the feelings of isolation, helplessness and hopelessness, to reduce fear and anxiety regarding treatments, and to assist in clarifying misperceptions and misinformation. Since there exists 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 and utilizing social support resource as well as improving life style and compliance with medical regimens. Group psychosocial intervention for persons at genetic high-risk, as well as those with early and advanced cancer, will be carried out.




	20. Psycho-Oncology Division



		Established in September 1995, the Psycho-Oncology Division of the Research Institute East has focused on two aspects of cancer; (1) the psychosocial impacts of cancer on the quality of life of the patient, family and staff, and (2) the role that psychosocial and behavioral variables may have in cancer risk and survival. Psychiatric Epidemiology in Cancer Patients 　Psychiatric prevalence studies in Western countries has revealed that approximately half of patients with all stages of cancer showed distress, with depression being the most common manifestation. Why depression? The frequently observed depression in cancer patients seems to be related to truth-telling practice in cancer care^(254,255) (e.g. disclosure of the diagnosis, recurrence, genetic high-risk).⁽²⁵⁶⁾ Since a few studies have demonstrated the extensive range of psychiatric disorders in patients with different clinical courses of cancer, patients with early, advanced and recurrent cancer are now systematically assessed using SCID. The preliminary results of these prevalence studies has shown that major depression and adjustment disorder with depressive mood were most common in Japanese cancer patients.^(257,258) 　Four hundred fifty-five ambulatory cancer patients were systemically assessed using Mental Adjustment to Cancer Scale.⁽²⁵⁹⁾ This survey revealed that positive coping to cancer, namely Fighting Spirit, was negatively correlated with depressive mood and that support from physician and satisfaction with social support predicted Fighting Spirit. Diagnosing Depression in Cancer Patients 　Depression is frequently under-estimated and undertreated even in advanced cancer 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 symptomatic cancer, cancer treatment or depression. It is important to diagnose depression in cancer patients appropriately, since depression may diminish the patientﾕs competence, especially terminally ill cancer patients with a desire for death. Furthermore, 5-HT-_2A receptor-mediated calcium mobilization has been investigated in rat glioma cells.^(260-263) Diagnosing depression with serotonin-induced calcium mobilization in platelets of cancer patients with/without depression is now ongoing,⁽²⁵⁷⁾ since many studies have indicated an abnormality involving 5-HT-2A receptor-mediated signaling systems in affective disorders. 　Using the validated Japanese version of the Hospital Anxiety and Depression Scale, an optimal cut-off point for screening for adjustment disorder and major depression was determined as 10/11 whereas that for major depression was 19/20.⁽²⁶⁴⁾ Symptom Management 　Depression is frequently observed in patients with all stages of cancer. Although the use of antidepressants is thought to be beneficial for cancer patients, it is often not possible to use psychotropics due to adverse effects of oversedation, rarely neuroleptic malignant syndrome,⁽²⁶⁵⁾ gastrointestinal obstruction and the nature of its slow effects. Furthermore, there are no universally accepted guidelines for its usage in cancer patients. An algorithm for the psychopharmacological treatment of depression in advanced cancer patients has been developed.⁽²⁵⁷⁾ 　Although fatigue is also frequently observed in patients with depression as well as advanced cancer, its mechanism is still unknown. Cancer fatigue must be studied both physically and psychosocially in cancer patients with/without depression. To investigate the pathophysiology of fatigue syndrome and establish a treatment for fatigue in cancer patients, the development of appropriate instruments to assess the symptoms of fatigue in cancer patients are now in progress. 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 surviving for longer periods. The primary goals of psychosocial interventions designed for cancer patients are improved quality of life; to decrease the feeling of alienation by talking with other cancer patients in a similar situation, to lessen the feelings of isolation, helplessness and hopelessness, to reduce fear and anxiety regarding treatments, and to assist in clarifying misperceptions and misinformation. Since there exists 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 and utilizing social support resource as well as improving life style and compliance with medical regimens. Group psychosocial intervention for persons at genetic high-risk, as well as those with early and advanced cancer, will be carried out.