Department of General Internal Medicine/Oncologic Emergencies
Ken Ohashi, Hisashi Baba, Keiichiro Osame, Masaaki Shoji, Takeshi Iwasa, Keiji Okinaka, Yukiko Okazaki
The increasing number of cancer patients who visit the National Cancer Center Hospital have a wide range of non-cancer-related medical problems such as diabetes, hypertension, heart diseases, and kidney diseases. Cancer or its treatment can aggravate the pre-existing medical conditions and sometimes can cause these problems. These medical issues must be addressed and managed along with the cancer itself so that our patients can go through optimal cancer therapies and have a better outcome. The Department of General Internal Medicine was reorganized in October 2010 to better serve these diverse needs of cancer patients and provide more comprehensive, patient-centered care. Our staff have experience and expertise in their respective fields and provide comprehensive management of these issues.
We see cancer patients on both an inpatient and outpatient basis in consultation upon the request of NCCH cancer specialists. Reasons for consultation include preoperative assessment of surgical risks, assessment of ischemic heart disease, management of hyperglycemia, treatment of heart and renal failure, management of infections, and other medical disorders. When necessary, we also offer appropriate referral to other health care facilities for further evaluation or treatment. In addition, patients seen in consultation may be followed after discharge as outpatients for the duration of their care at the NCCH. Since April 2011, we have expanded diabetes consultation services into the NCC Hospital East, improving the quality of diabetes care there.
Cardiologists take charge of ECG, echocardiography, in-hospital consultation, and the outpatient clinic. Consultations include preoperative assessment of surgical risks, assessment of ischemic heart disease, management of arrhythmia, management of heart failure, and management of other cardiological problems. The number of consultations is about 2,000 a year. When an emergency procedure is necessary, we consider transferring the patient to other facilities that have specialists. Recently, the number of clinical trials for cancer that require echocardiography assessment has been increasing, so we make every effort to practice tests more efficiently.
We provided more than 600 diabetes consultations in 2015, which include perioperative management of diabetes and treatment of steroid-induced hyperglycemia during chemotherapy. In many cases, initiation of insulin is the treatment of choice. We also offer close follow-ups on an outpatient basis for those who have diabetes during their cancer treatment at the NCCH.
Since August 2015, an Infectious Disease specialist has provided about 200 consultations including active interventions triggered by positive blood culture. An ID physician has been also responsible for control of healthcare-associated infections as the Chief of the Infection Control Team. Implementation of antimicrobials stewardship is the other main task of the ID physician in collaboration with pharmacists. Through these activities, we aim to provide safer and higher-quality cancer care in the NCCH.