Annual Report 2019
Department of General Internal Medicine
Cardiology: Masaaki Shoji, Takeshi Iwasa
Diabeto-oncology / Endocrinology: Ken Ohashi, Keiichiro Osame, Yukiko Okazaki, Atsushi Goto
Introduction
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 cause these problems. These medical issues must be addressed and managed along with the cancer itself so that our patients can benefit from optimal cancer therapies and we can improve their prognosis. The Department of General Internal Medicine was reorganized in October 2010 to better serve the diverse needs of such cancer patients and provide more comprehensive, patient-centric cancer care. Our staff have experience and expertise in their respective fields and manage these issues comprehensively.
The Team and What We Do
We consult with cancer patients on both an inpatient and outpatient basis at the request of NCCH cancer specialists. The reasons 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 up after discharge as outpatients for the duration of their care at the NCCH.
Cardiology:
The Department of Cardiology deals with cardiovascular disease (heart disease and vascular disease). The subjects are ischemic heart diseases (angina and myocardial infarction), arrhythmia, cardiomyopathy, valvular heart disease, lower limb arteriovenous thrombosis and the like. Mainly, the condition of the heart during the perioperative period or chemotherapy is evaluated by using an electrocardiogram and echocardiography, and the heart is managed so that the cancer patient can receive the best treatment. Cardiovascular disease can sometimes suddenly become life threatening and may require urgent treatment. In such cases, we cooperate with neighborhood hospitals that can provide emergency treatment such as catheter treatment and highly intensive treatment. In recent years, onco-cardiology has been prospering as an interdisciplinary area that connects the cancer and cardiovascular fields, and we are also studying the effects of anticancer agents on cardiac function and venous thrombosis, which is often found in cancer patients.
Future prospects
In the future, we plan to further advance the current research. Especially for venous thrombosis, a new anticoagulant (NOAC) has started to be indicated and is expected to replace the conventionally used warfarin, so it is important to investigate the efficacy and safety in cancer patients. Although some data are collected at this hospital, it is necessary to carry out research jointly with other institutions. J-COSMOS (Japanese Cardio-Oncology network for Scientific Methodologies to improve the Outcome of cancer Survivors), which we are also involved in as an executive committee, is an onco-cardiology network for basic research, clinical research, and epidemiological research all over Japan.
Diabeto-oncology/Endocrinology:
We provided more than 700 diabetes consultations in 2019, including perioperative management of diabetes, treatment of steroid-induced hyperglycemia during chemotherapy and so on. In many cases, initiation of insulin was the treatment of choice. We also offered close follow-up on an outpatient basis for those with diabetes during their cancer treatment at the NCCH. Alongside the expanding use of immune checkpoint inhibitors, cases of immune-related endocrinopathies, such as type 1 diabetes, thyroiditis and hypophysitis leading to adrenal insufficiency, soared in 2019. It is noteworthy that we have experienced 36 cases of immune-related type 1 diabetes since 2015.
List of papers published in 2019
Journal
1. Shoji M, Suzuki S, Otsuka T, Arita T, Yagi N, Semba H, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Matsuhama M, Yajima J, Yamashita T. A Simple Formula for Predicting the Maintenance Dose of Warfarin with Reference to the Initial Response to Low Dosing at an Outpatient Clinic. Intern Med, 59:29-35, 2020
2. Saito E, Goto A, Kanehara R, Ohashi K, Noda M, Matsuda T, Katanoda K. Prevalence of diabetes in Japanese patients with cancer. J Diabetes Investig, 2020
3. Iizumi S, Kuchiba A, Okusaka T, Ikeda M, Sakamoto Y, Kondo S, Morizane C, Ueno H, Osame K, Mitsunaga S, Ohno I, Imaoka H, Hashimoto Y, Takahashi H, Sasaki M, Ohashi K. Impact of the Duration of Diabetes Mellitus on the Outcome of Metastatic Pancreatic Cancer Treated with Gemcitabine: A Retrospective Study. Intern Med, 58:2435-2441, 2019
4. Inada S, Iizuka Y, Ohashi K, Kikuchi H, Yamamoto Y, Kadowaki T, Yoshiuchi K. Preceding psychological factors and calorie intake in patients with type 2 diabetes: investigation by ecological momentary assessment. Biopsychosoc Med, 13:20, 2019