PSYCHO-ONCOLOGY DIVISION

26.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 play in cancer risk and survival. Established in September 1995, the Psycho-Oncology Division has focused on the psycho-social impacts of cancer on patient QOL, especially depression.
Depression in Cancer Patients

    Depression is well known to be among the most common expressions of psychological distress in cancer patients ⁽³¹⁴⁾. Despite the high prevalence of depression in cancer patients, it is poorly recognized and not appropriately treated ⁽³¹⁵⁾. To clarify the clinical course of depression in non-small cell lung cancer (NSCLC) patients during the year after surgery and to identify predictors of their long-term outcome, a total of 212 patients completed assessments during a 12-month follow-up period after curative resection of NSCLC ^(316,³¹⁷⁾. The prevalence of depression did not change during the year after curative resection (4.7-8.0%). A depression episode at 1 month after surgery and "less educated" were significant predictors of depression at 12 months. These results suggest the need for psychosocial support even after curative resection of NSCLC and that an approach which includes postoperative assessment of depression and careful attention to less educated patients might be of benefit to patients in ameliorating depression during the year after curative resection.
    To develop a new, brief screening tool for depression, a total of 275 cancer patients completed the newly developed the One-Question Interview (a 1-item, structured interview); the Distress Thermometer (a 1-item, self-report questionnaire); and the Hospital Anxiety and Depression Scale (a 14-item, self-report questionnaire; ⁽³¹⁸⁾). The results suggest that the One-Question Interview had good sensitivity (84%) and specificity (61%). Its performance was inferior to that of the HADS but comparable to that of the Distress Thermometer. The One-Question Interview may be suitable for widespread use in routine care and this valid tool with appropriate psychotherapeutic and psychopharmacological interventions for depression in cancer patients may be a promising strategy.
Other Psychological Distress in Cancer Patients

    Having cancer is extremely stressful, and distressing cancer-related recollections, one of the PTSD symptoms, are frequently reported by medical staff as well as cancer survivors ⁽³¹⁹⁾. Smaller left hippocampal volume was observed in breast cancer survivors with distressing cancer-related recollections, which is consistent with the hippocampal findings in patients with stress-related neuropsychiatric disorders, such as PTSD and depression. To examine further the relationship between distressing cancer-related recollections and emotional memory consolidation in breast cancer survivors, the amygdale volume was examined using 3-D MRI imaging ⁽³²⁰⁾. The volume of the left amygdale, but not the left hemisphere, was significantly smaller (5.7%) in the subjects with a history of distressing cancer-related recollections (N=35) than in those without any such history (n=41). the results suggested that having distressing cancer-related recollections is associated with the left amygdale as well as the left hippocampus in survivors of breast cancer. A longitudinal study is ongoing to elucidate when amygdale and hippocampal alterations occur.
    To identify gender differences in the impact of daily living activities impairment, 502 ambulatory cancer patients completed the interview and distress scale ⁽³²¹⁾. The results suggested that mild impairment of daily activities (performance status=1) was associated with poor psychological responses in females, but not males. to identify gender differences in the impact of marital status, 524 ambulatory cancer patients completed the interview and distress scale ⁽³²²⁾. The results suggested being unmarried may be a risk factor for psychological distress for men with cancer.
    Group psychosocial interventions for breast cancer survivors include providing medical and psychological information, mutual support, as well as coping skills. Information and mutual support may have a beneficial impact on both the information need and reducing loneliness. A retrospective analysis of a randomized clinical trail for such survivors demonstrated that the intervention is also beneficial for Japanese breast cancer survivors experiencing low satisfaction with information and mutual support and distressing loneliness ^(323,³²⁴⁾.
    To investigate whether a communication skills training (CST) program on breaking bad news that has been developed in the West would be useful for Japanese oncologists, the self-rated confidence in communication with cancer patients was assessed before and after the CST ⁽³²⁵⁾. Immediately and at 3 months after the CST, the confidence in communication of 58 oncologists increased significantly compared with before, suggesting the CST for Japanese oncologists is feasible.
Refractory Symptoms in Advanced Cancer

    Cancer patients frequently suffer from a myriad of symptoms ^(326-³²⁹⁾. Fatigue and dyspnea are one of the most frequent and refractory symptoms in cancer patients. To use a concise assessment tool, the Japanese version of the Brief Fatigue Inventory was examined. The results suggested that this scale is a brief, valid, reliable and feasible measure of fatigue for use with Japanese cancer patients ⁽³³⁰⁾. The development of the comprehensive assessment tool is essential to the effective management of these symptoms. The results suggested that the MD Anderson Symptom Inventory is a brief, valid, and reliable tool for Japanese cancer patients ⁽³³¹⁾. These assessment scales represent a first step in the therapeutic strategy to reduce pain and other refractory symptoms.




26.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 play in cancer risk and survival. Established in September 1995, the Psycho-Oncology Division has focused on the psycho-social impacts of cancer on patient QOL, especially depression. Depression in Cancer Patients Depression is well known to be among the most common expressions of psychological distress in cancer patients ⁽³¹⁴⁾. Despite the high prevalence of depression in cancer patients, it is poorly recognized and not appropriately treated ⁽³¹⁵⁾. To clarify the clinical course of depression in non-small cell lung cancer (NSCLC) patients during the year after surgery and to identify predictors of their long-term outcome, a total of 212 patients completed assessments during a 12-month follow-up period after curative resection of NSCLC ^(316,³¹⁷⁾. The prevalence of depression did not change during the year after curative resection (4.7-8.0%). A depression episode at 1 month after surgery and "less educated" were significant predictors of depression at 12 months. These results suggest the need for psychosocial support even after curative resection of NSCLC and that an approach which includes postoperative assessment of depression and careful attention to less educated patients might be of benefit to patients in ameliorating depression during the year after curative resection. To develop a new, brief screening tool for depression, a total of 275 cancer patients completed the newly developed the One-Question Interview (a 1-item, structured interview); the Distress Thermometer (a 1-item, self-report questionnaire); and the Hospital Anxiety and Depression Scale (a 14-item, self-report questionnaire; ⁽³¹⁸⁾). The results suggest that the One-Question Interview had good sensitivity (84%) and specificity (61%). Its performance was inferior to that of the HADS but comparable to that of the Distress Thermometer. The One-Question Interview may be suitable for widespread use in routine care and this valid tool with appropriate psychotherapeutic and psychopharmacological interventions for depression in cancer patients may be a promising strategy. Other Psychological Distress in Cancer Patients Having cancer is extremely stressful, and distressing cancer-related recollections, one of the PTSD symptoms, are frequently reported by medical staff as well as cancer survivors ⁽³¹⁹⁾. Smaller left hippocampal volume was observed in breast cancer survivors with distressing cancer-related recollections, which is consistent with the hippocampal findings in patients with stress-related neuropsychiatric disorders, such as PTSD and depression. To examine further the relationship between distressing cancer-related recollections and emotional memory consolidation in breast cancer survivors, the amygdale volume was examined using 3-D MRI imaging ⁽³²⁰⁾. The volume of the left amygdale, but not the left hemisphere, was significantly smaller (5.7%) in the subjects with a history of distressing cancer-related recollections (N=35) than in those without any such history (n=41). the results suggested that having distressing cancer-related recollections is associated with the left amygdale as well as the left hippocampus in survivors of breast cancer. A longitudinal study is ongoing to elucidate when amygdale and hippocampal alterations occur. To identify gender differences in the impact of daily living activities impairment, 502 ambulatory cancer patients completed the interview and distress scale ⁽³²¹⁾. The results suggested that mild impairment of daily activities (performance status=1) was associated with poor psychological responses in females, but not males. to identify gender differences in the impact of marital status, 524 ambulatory cancer patients completed the interview and distress scale ⁽³²²⁾. The results suggested being unmarried may be a risk factor for psychological distress for men with cancer. Group psychosocial interventions for breast cancer survivors include providing medical and psychological information, mutual support, as well as coping skills. Information and mutual support may have a beneficial impact on both the information need and reducing loneliness. A retrospective analysis of a randomized clinical trail for such survivors demonstrated that the intervention is also beneficial for Japanese breast cancer survivors experiencing low satisfaction with information and mutual support and distressing loneliness ^(323,³²⁴⁾. To investigate whether a communication skills training (CST) program on breaking bad news that has been developed in the West would be useful for Japanese oncologists, the self-rated confidence in communication with cancer patients was assessed before and after the CST ⁽³²⁵⁾. Immediately and at 3 months after the CST, the confidence in communication of 58 oncologists increased significantly compared with before, suggesting the CST for Japanese oncologists is feasible. Refractory Symptoms in Advanced Cancer Cancer patients frequently suffer from a myriad of symptoms ^(326-³²⁹⁾. Fatigue and dyspnea are one of the most frequent and refractory symptoms in cancer patients. To use a concise assessment tool, the Japanese version of the Brief Fatigue Inventory was examined. The results suggested that this scale is a brief, valid, reliable and feasible measure of fatigue for use with Japanese cancer patients ⁽³³⁰⁾. The development of the comprehensive assessment tool is essential to the effective management of these symptoms. The results suggested that the MD Anderson Symptom Inventory is a brief, valid, and reliable tool for Japanese cancer patients ⁽³³¹⁾. These assessment scales represent a first step in the therapeutic strategy to reduce pain and other refractory symptoms.