PSYCHO- ONCOLOGY DIVISION

20.PSYCHO- ONCOLOGY DIVISION

　Psycho- Oncology has focused on two aspects of cancer;the psychosocial impacts of cancer on the quality of life (QOL)of the patient, family and staff, and the role that psychosocial and behavioral factors may have in cancer risk and survival.⁽²⁶⁴⁾ Established in September 1995, the Psycho- Oncology Division has focused on the psychosocial impacts of cancer on the QOL of the patient.
Psychiatric Epidemiology in Cancer Patients

　Psychiatric prevalence studies in Western countries have 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 with truth- telling practice in cancer care (e.g. disclosure of the diagnosis, recurrence, termination of the curative treatments, and genetic high- risk). Since a few studies 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 the Semi- structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID). The preliminary investigation using the Mental Adjustment to Cancer scale and the Profile of Mood States has demonstrated that depression was common and was significantly associated with advanced disease, being unmarried and helpless/hopeless coping in 99 ambulatory head and neck cancer patients.⁽²⁶⁵⁾
　Encountering suicidal thoughts is not so rare in clinical oncology, but associated factors with patient characteristics are still unknown. Retrospective analysis of 14 cancer patients referred for psychiatric consultation suggested that the suffering from depression and delirium as well as advanced cancer and poor physical functioning might be associated with suicidal thoughts.⁽²⁶⁶⁾
Screening for Psychiatric Disorders in Cancer Patients

　Nicotine and alcohol dependence ⁽²⁶⁷⁾ are the refractory substance dependence disorders, and the former is considered to be a predictor of the success or failure at stopping smoking. To identify smoking- related cancer patients who will have difficulty stopping smoking, a Japanese version of the Fagerstrom test for nicotine dependence (FTND)was developed and compiled while the cancer patients were being simultaneously assessed using SCID. One hundred and fifty- one lung and head and neck cancer patients participated in this study. The results showed that an optimal cut- off point for screening for nicotine dependence was 5/6.⁽²⁶⁸⁾ These results suggested that the Japanese version of the FTND is a reliable and valid measure of nicotine dependence in patients with smoking- related cancers.
Pharmacological Intervention for Depression and Other Symptoms

　Although the use of antidepressants is thought to be beneficial for cancer patients,⁽²⁶⁹⁾ it is often not possible to use the psychotropics due to adverse effects of oversedation, gastrointestinal obstruction and their nature of slow effects. Furthermore, there are no universally accepted guidelines for usage of antidepressants in cancer patients. An algorithm for the psychopharmacological treatment of depression in advanced cancer patients has been developed.^(270-²⁷²⁾
　Although fatigue is also observed in patients with depression as well as advanced cancer, little is known about its association with other factors, including demographic, medical, and psychosocial factors. A total of 455 ambulatory cancer patients was assessed systematically and completed questionnaires including fatigue score.⁽²⁷³⁾ The results demonstrated that sex, education, employment status, the size of the household, the performance status, and depressive mood were associated with fatigue. These findings reveal that fatigue in cancer patients is multi- factorial. To investigate the pathophysiology of fatigue syndrome and establish a treatment for fatigue in cancer patients, we are currently developing appropriate instruments to assess the symptoms of fatigue in cancer patients.
Psychosocial and Behavioral Intervention for Distress and Coping

　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 QOL;to decrease the feeling of alienation by talking with other cancer patients in a similar situation, to lessen the feelings of isolation, helpless/hopeless coping, to reduce fear and anxiety regarding treatments and to assist in clarifying misperceptions and misinformation. It is not clear whether there is a weak link between psychosocial and behavioral factors and the subsequent development of cancer. However, the second goal is expected to exert beneficial effects on survival presumably by enhancing effective cancer coping skills and reducing psychological distress as well as improving lifestyle and compliance with medical regimens.
　To determine the effect of a psychosocial group intervention in reducing psychological distress and enhancing coping in Japanese cancer patients, a randomized controlled trial has just been conducted in patients with early breast cancer.




20.PSYCHO- ONCOLOGY DIVISION



	Psycho- Oncology has focused on two aspects of cancer;the psychosocial impacts of cancer on the quality of life (QOL)of the patient, family and staff, and the role that psychosocial and behavioral factors may have in cancer risk and survival.⁽²⁶⁴⁾ Established in September 1995, the Psycho- Oncology Division has focused on the psychosocial impacts of cancer on the QOL of the patient. Psychiatric Epidemiology in Cancer Patients 　Psychiatric prevalence studies in Western countries have 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 with truth- telling practice in cancer care (e.g. disclosure of the diagnosis, recurrence, termination of the curative treatments, and genetic high- risk). Since a few studies 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 the Semi- structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID). The preliminary investigation using the Mental Adjustment to Cancer scale and the Profile of Mood States has demonstrated that depression was common and was significantly associated with advanced disease, being unmarried and helpless/hopeless coping in 99 ambulatory head and neck cancer patients.⁽²⁶⁵⁾ 　Encountering suicidal thoughts is not so rare in clinical oncology, but associated factors with patient characteristics are still unknown. Retrospective analysis of 14 cancer patients referred for psychiatric consultation suggested that the suffering from depression and delirium as well as advanced cancer and poor physical functioning might be associated with suicidal thoughts.⁽²⁶⁶⁾ Screening for Psychiatric Disorders in Cancer Patients 　Nicotine and alcohol dependence ⁽²⁶⁷⁾ are the refractory substance dependence disorders, and the former is considered to be a predictor of the success or failure at stopping smoking. To identify smoking- related cancer patients who will have difficulty stopping smoking, a Japanese version of the Fagerstrom test for nicotine dependence (FTND)was developed and compiled while the cancer patients were being simultaneously assessed using SCID. One hundred and fifty- one lung and head and neck cancer patients participated in this study. The results showed that an optimal cut- off point for screening for nicotine dependence was 5/6.⁽²⁶⁸⁾ These results suggested that the Japanese version of the FTND is a reliable and valid measure of nicotine dependence in patients with smoking- related cancers. Pharmacological Intervention for Depression and Other Symptoms 　Although the use of antidepressants is thought to be beneficial for cancer patients,⁽²⁶⁹⁾ it is often not possible to use the psychotropics due to adverse effects of oversedation, gastrointestinal obstruction and their nature of slow effects. Furthermore, there are no universally accepted guidelines for usage of antidepressants in cancer patients. An algorithm for the psychopharmacological treatment of depression in advanced cancer patients has been developed.^(270-²⁷²⁾ 　Although fatigue is also observed in patients with depression as well as advanced cancer, little is known about its association with other factors, including demographic, medical, and psychosocial factors. A total of 455 ambulatory cancer patients was assessed systematically and completed questionnaires including fatigue score.⁽²⁷³⁾ The results demonstrated that sex, education, employment status, the size of the household, the performance status, and depressive mood were associated with fatigue. These findings reveal that fatigue in cancer patients is multi- factorial. To investigate the pathophysiology of fatigue syndrome and establish a treatment for fatigue in cancer patients, we are currently developing appropriate instruments to assess the symptoms of fatigue in cancer patients. Psychosocial and Behavioral Intervention for Distress and Coping 　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 QOL;to decrease the feeling of alienation by talking with other cancer patients in a similar situation, to lessen the feelings of isolation, helpless/hopeless coping, to reduce fear and anxiety regarding treatments and to assist in clarifying misperceptions and misinformation. It is not clear whether there is a weak link between psychosocial and behavioral factors and the subsequent development of cancer. However, the second goal is expected to exert beneficial effects on survival presumably by enhancing effective cancer coping skills and reducing psychological distress as well as improving lifestyle and compliance with medical regimens. 　To determine the effect of a psychosocial group intervention in reducing psychological distress and enhancing coping in Japanese cancer patients, a randomized controlled trial has just been conducted in patients with early breast cancer.