PSYCHO-ONCOLOGY DIVISION

22.PSYCHO-ONCOLOGY DIVISION

    Psycho-Oncology has focused on two aspects of cancer; the psychosocial impacts of cancer on quality of life (QOL) for the patient, family and staff, and the role that psychosocial and behavioral factors may have in cancer risk and survival. Established in September 1995, the Psycho-Oncology Division has focused on the psychosocial impacts of cancer on patient QOL, especially depression.
Psychiatric Epidemiology of Depression and Other Forms of Psychological Distress 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. To clarify the prevalence of and factors correlating with depression in Japanese cancer patients after disclosure of a cancer diagnosis including recurrence, termination of curative treatments, and genetic high-risk, patients with various stages of cancer are now systematically being assessed using the Semi-structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID). Of 223 newly diagnosed non-small lung cancer patients undergoing successful surgical treatment, 15% met the criteria for depression. ⁽²²⁹⁾ Of 107 newly diagnosed head and neck cancer patients and 55 recurrent breast cancer patients, 17% and 42% met the criteria for depression or adjustment disorders, respectively. ^(230,²³¹⁾ The correlative factors were low social support, living alone and a disease-free interval of less than 24 months. The results suggest that it is important for all oncology staff members to pay careful attention to cancer patients facing survivorship, loneliness and early recurrence.
Psychiatric Intervention for Depression and Other Forms of Psychological Distress in Cancer Patients

    The need for a large variety of psychosocial interventions has increased along with rising numbers of cancer patients surviving for longer periods. The primary goal of psychosocial interventions designed for cancer patients is enhancement of QOL. ^(232,²³³⁾ The 6-week, structured, psychosocial group intervention for Japanese cancer patients was performed to assess effects in reducing psychological distress and enhancing coping in a randomized controlled trial. ^(234,²³⁵⁾ Fifty (31%) of the 151 postoperative early breast cancer patients participated and were randomized, and 46 (30%) completed the study. The experimental group had significantly lower psychological distress scores than the controls, and significantly higher coping scores "fighting spirit"at the 6-month follow-up as well as at the end of the 6-week intervention. The results suggest that a short term psychosocial group intervention might produce significant long term improvement in the QOL of Japanese cancer patients.
    To investigate the effect of cancer patients understanding their own disease on their survival potential after being given the diagnosis by their physician, 214 women with metastatic breast cancer who participated in a multi-institutional, randomized phase III trial were asked whether they understood their own disease after being given information about the clinical trial. The 'better understanding' group (n=190) showed significantly longer survival than the 'poor understanding' group (n=24, median survival times after registration were 28.3 and 16.1 months, respectively). ⁽²³⁶⁾ The results support the supposition that a patient's understanding of information about the disease may influence survival.
Refractory Symptoms in Advanced Cancer

    Encountering suicidal thoughts is not rare in clinical oncology. To clarify the factors correlating with suicidal thoughts in cancer patients with depression, consultation data on referred patients were examined. The results suggest that the older the patient and more severe the depression, with the same being true of advanced stage and poor physical functioning, the more likely are suicidal thoughts. ^(237,²³⁸⁾
    Fatigue and dyspnea are among of the most frequent and refractory symptoms in cancer patients. ⁽²³⁹⁾ Lack of an appropriate assessment tool for these symptoms makes the establishment of a management strategy more difficult. Brief self-rating scales, namely the Cancer Fatigue Scale (CFS) and the Cancer Dyspnea Scale (CDS), were developed and validated to assess the multi-dimensional nature of the symptoms experienced by cancer patients. ^(240,²⁴¹⁾ The CFS is a 15-item scale composed of 3 subscales (physical, affective and cognitive). The CDS is a 12-item scale composed of 3 subscales (sense of effort, sense of anxiety and sense of discomfort).




22.PSYCHO-ONCOLOGY DIVISION



	Psycho-Oncology has focused on two aspects of cancer; the psychosocial impacts of cancer on quality of life (QOL) for the patient, family and staff, and the role that psychosocial and behavioral factors may have in cancer risk and survival. Established in September 1995, the Psycho-Oncology Division has focused on the psychosocial impacts of cancer on patient QOL, especially depression. Psychiatric Epidemiology of Depression and Other Forms of Psychological Distress 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. To clarify the prevalence of and factors correlating with depression in Japanese cancer patients after disclosure of a cancer diagnosis including recurrence, termination of curative treatments, and genetic high-risk, patients with various stages of cancer are now systematically being assessed using the Semi-structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID). Of 223 newly diagnosed non-small lung cancer patients undergoing successful surgical treatment, 15% met the criteria for depression. ⁽²²⁹⁾ Of 107 newly diagnosed head and neck cancer patients and 55 recurrent breast cancer patients, 17% and 42% met the criteria for depression or adjustment disorders, respectively. ^(230,²³¹⁾ The correlative factors were low social support, living alone and a disease-free interval of less than 24 months. The results suggest that it is important for all oncology staff members to pay careful attention to cancer patients facing survivorship, loneliness and early recurrence. Psychiatric Intervention for Depression and Other Forms of Psychological Distress in Cancer Patients The need for a large variety of psychosocial interventions has increased along with rising numbers of cancer patients surviving for longer periods. The primary goal of psychosocial interventions designed for cancer patients is enhancement of QOL. ^(232,²³³⁾ The 6-week, structured, psychosocial group intervention for Japanese cancer patients was performed to assess effects in reducing psychological distress and enhancing coping in a randomized controlled trial. ^(234,²³⁵⁾ Fifty (31%) of the 151 postoperative early breast cancer patients participated and were randomized, and 46 (30%) completed the study. The experimental group had significantly lower psychological distress scores than the controls, and significantly higher coping scores "fighting spirit"at the 6-month follow-up as well as at the end of the 6-week intervention. The results suggest that a short term psychosocial group intervention might produce significant long term improvement in the QOL of Japanese cancer patients. To investigate the effect of cancer patients understanding their own disease on their survival potential after being given the diagnosis by their physician, 214 women with metastatic breast cancer who participated in a multi-institutional, randomized phase III trial were asked whether they understood their own disease after being given information about the clinical trial. The 'better understanding' group (n=190) showed significantly longer survival than the 'poor understanding' group (n=24, median survival times after registration were 28.3 and 16.1 months, respectively). ⁽²³⁶⁾ The results support the supposition that a patient's understanding of information about the disease may influence survival. Refractory Symptoms in Advanced Cancer Encountering suicidal thoughts is not rare in clinical oncology. To clarify the factors correlating with suicidal thoughts in cancer patients with depression, consultation data on referred patients were examined. The results suggest that the older the patient and more severe the depression, with the same being true of advanced stage and poor physical functioning, the more likely are suicidal thoughts. ^(237,²³⁸⁾ Fatigue and dyspnea are among of the most frequent and refractory symptoms in cancer patients. ⁽²³⁹⁾ Lack of an appropriate assessment tool for these symptoms makes the establishment of a management strategy more difficult. Brief self-rating scales, namely the Cancer Fatigue Scale (CFS) and the Cancer Dyspnea Scale (CDS), were developed and validated to assess the multi-dimensional nature of the symptoms experienced by cancer patients. ^(240,²⁴¹⁾ The CFS is a 15-item scale composed of 3 subscales (physical, affective and cognitive). The CDS is a 12-item scale composed of 3 subscales (sense of effort, sense of anxiety and sense of discomfort).