Department of Psycho-Oncology Service

Asao Ogawa, Masanori Enokido, Yusei Iwata, Daisuke Fujisawa, Mayumi Takahashi

Introduction

The aim of the Department of Psycho-Oncology Service is to develop mind-centered interventions to restore, maintain, and improve the quality of life of patients and their families throughout cancer treatment, and in the end-of-life period. Our Service has focused on developing effective interventions for delirium, dementia, and depression in cancer patients as well as on determining the mechanism underlying the relationship between cancer and the mind through a combination of neuropsychiatric, psychosocial, and behavioral sciences.

In particular, increases in the number of individuals diagnosed with cancer each year, due in large part to the growth of the aging population, as well as improving survival rates, have resulted in an ever-increasing number of elderly cancer patients with deteriorating cognitive functions. Therefore, we conduct research on the development and validation of geriatric assessments such as Mini-Cog, comprehensive geriatric assessment (CGA), etc., and the evaluation of effectiveness of multidisciplinary interventions among hospitalized cancer patients with delirium or cognitive function disorder, including mild cognitive impairment.

The Team and What We Do

The Department of Psycho-Oncology Service is composed of three attending psychiatrists and three clinical psychologists. The clinical activity includes psychiatric consultation involving comprehensive assessment and addressing the psychiatric problems of cancer patients. The patients are either self-referred or referred by their oncologist in charge. The consultation data are shown in Tables 1 and 2. Psychiatric diagnosis is based on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorder, 5th edition) criteria. The consultation data also include individuals who are family members of cancer patients.

Table 1. Supportive care team consultation data (n=1,789; April 2021 to March 2022)


Table 2. Psycho-oncology outpatient consultation data (n=694; April 2021 to March 2022)


A conference with the Supportive Care Team is held every Wednesday, and a multicenter joint clinical teleconference involving six cancer center hospitals and three university hospitals is held every Thursday.

Research activities

1.  A multicenter, cluster randomized controlled study comparing usual care and multidisciplinary interventions such as the DELirium Team Approach-program (DELTA program) to prevent the development and reduce the severity of delirium among hospitalized cancer patients (Research and Development grants for cancer at the Japan Agency for Medical Research and Development)

 Delirium, defined as an acute disorder of attention and global cognitive function, is a common, serious, and potentially preventable source of morbidity and mortality for hospitalized elderly people. Primary prevention, i.e., preventing delirium before it develops, is the most effective strategy for reducing delirium. We have reported the effectiveness of multidisciplinary intervention to prevent the development and reduce the severity of delirium among hospitalized patients, designed through a multicenter, cluster randomized controlled study.

2.  Development of a dementia care support system utilizing artificial intelligence that proposes prevention and early detection of BPSD and appropriate care (Health Labour Sciences Research Grant)

 With the growing number of elderly people, the prevalence of dementia with physical and mental conditions in acute care hospitals has increased. The purpose of this study is to disseminate appropriate dementia care in acute care hospitals in Japan through the development of a support system that utilizes artificial intelligence for physical care and dementia care for people with dementia.

 We have reported the educational effects of dementia care for acute care hospital nurses and plan to evaluate the clinical effects.

3.  Multicenter, double-blind, placebo-controlled, randomized controlled study for efficacy and safety of ramelteon in preventing postoperative delirium in delirium high-risk cancer patients (Research and Development grants for cancer at the Japan Agency for Medical Research and Development)

Delirium is common in the elderly and is associated with worsening surgical outcomes, decreased quality of life, and mortality, but no standard pharmacological preventive measures have been established. We are planning to start a multicenter, double-blind, placebo controlled trial to verify the delirium preventive effects and safety of the melatonin agonist ramelteon in elderly people before cancer surgery.

List of papers published

Journal

1. Matsumoto Y, Umemura S, Okizaki A, Fujisawa D, Kobayashi N, Tanaka Y, Sasaki C, Shimizu K, Ogawa A, Kinoshita H, Uchitomi Y, Yoshiuchi K, Matsuyama Y, Morita T, Goto K, Ohe Y. Early specialized palliative care for patients with metastatic lung cancer receiving chemotherapy: a feasibility study of a nurse-led screening-triggered programme. Japanese journal of clinical oncology, 52:375-382, 2022

2. Sakata N, Okumura Y, Ogawa A. Postoperative Pain Treatment in Patients with Dementia: A Retrospective Observational Study. Drugs & aging, 39:305-311, 2022

3. Hirooka K, Okumura Y, Matsumoto S, Fukahori H, Ogawa A. Quality of End-of-Life in Cancer Patients With Dementia: Using A Nationwide Inpatient Database. Journal of pain and symptom management, 2022

4. Maeda I, Inoue S, Uemura K, Tanimukai H, Hatano Y, Yokomichi N, Amano K, Tagami K, Yoshiuchi K, Ogawa A, Iwase S. Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study. Journal of palliative medicine, 24:914-918, 2021

5. Ando C, Kanno Y, Uchida O, Nashiki E, Kosuge N, Ogawa A. Pain management in community-dwelling older adults with moderate-to-severe dementia. International journal of palliative nursing, 27:158-166, 2021

6. Kizawa Y, Yamaguchi T, Yagi Y, Miyashita M, Shima Y, Ogawa A. Conditions, possibility and priority for admission into inpatient hospice/palliative care units in Japan: a nationwide survey. Japanese journal of clinical oncology, 51:1437-1443, 2021

7. Nakazawa Y, Kato M, Miyashita M, Morita T, Ogawa A, Kizawa Y. Growth and Challenges in Hospital Palliative Cancer Care Services: An Analysis of Nationwide Surveys Over a Decade in Japan. Journal of pain and symptom management, 61:1155-1164, 2021

8. Akechi T, Ito Y, Ogawa A, Kizawa Y. Essential competences for psychologists in palliative cancer care teams. Japanese journal of clinical oncology, 51:1587-1594, 2021