Annual Report 2019
Department of Psycho-Oncology
Full-time staff psycho-oncologists: Ken Shimizu, Rika Nakahara, Takatoshi Hirayama, Masashi Kato, Yosuke Uchitomi, Yutaka Matsuoka, Saho Wada
Full-time staff psychologists: Yuko Yanai, Yuko Ogawa
Part-time staff psychologists: Mariko Kobayashi, Hitomi Ninomiya, Akie Shindo, Moeko Tanaka
Introduction
The Department of Psycho-Oncology was reestablished in September 1995, together with the establishment of the Psycho-Oncology Division, National Cancer Center Research Institute East (reorganized to Division of Psycho-Oncology, Research Center for Innovative Oncology in 2005). One of the most important clinical activities of the department is the management of cancer patients’ behavioral and social problems as well as their psychological distress. Furthermore, this division’s aim is to alleviate the distress of patients, patients’ families and our staff. Research activity is focused on studying the psychosocial influence of cancer on the quality of life of patients, their families, and oncology staff.
The Team and What We Do
The Department of Psycho-Oncology consists of six full-time staff psychiatrists, one part-time psychiatrist, two full-time staff psychotherapists and three part-time psychotherapists. The department provides two major services: a clinic for outpatients (five days a week) and consultation for referred inpatients. The purpose of the psychiatric consultation is to diagnose and treat the mental distress and cancer-related psychological problems of patients who have been referred by their attending physicians. Since 1999, the department has played an active role as a member of the palliative care team. There is a palliative care team meeting with other members of the team every Tuesday. Additionally, a multicenter joint clinical teleconference to discuss difficult cases is held biweekly on Thursday evening with staff members from 6 cancer center hospitals and 4 university hospitals.
In 2019, a total of 1206 patients were referred for psychiatric consultation (Table 1). The mean age was 55.4 years old and 76.9 percent of the referrals were inpatients. Six-hundred and fifty-seven (54.5%) of the total referred patients were females (Table 1). The most common cancer referrals were patients with lung cancer (17.3%), followed by hematological cancer (15.1%), mesothelioma and soft tissue tumor (9.8%), colon cancer (9.2%), and head and neck cancer (7.2%). The most common psychiatric diagnosis which is based on the DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) was delirium (25.0%), followed by adjustment disorders (18.1%), and major depressive disorder (4.7%), while 26.2% of the referrals had no psychiatric diagnosis. The three common mental disorders (delirium, adjustment disorders, and major depressive disorder) were responsible for half of the psychological problems.
Table 1. Psychiatric Consultation Data in 2019 (n=1206)
Research activities
In collaboration with the Department of Hematopoietic Stem Cell Transplantation, we are planning to develop a psychological support program for allogeneic hematopoietic stem cell transplantation ("transplant") survivors. This year, we are publishing a multicenter study on the psychological distress of transplant survivors (812 cases at 24 centers). We have also begun a retrospective study at our center using pre-transplant assessment and medical records of patients who have used psycho-psychological support, with the aim of identifying psychological issues (e.g., psychological characteristics, support needs, etc.) among allogeneic transplant patients.
We have examined the usefulness of herbal medicine yokukansan as a prophylactic medicine for postoperative delirium. A single-center, pre-and-post intervention trial of a behavioral activation therapy program for depressed cancer patients in Japan is underway. To date, 24 patients (target number of patients: 32) have been enrolled.
We conducted semi-structured interviews with 40 of our AYA generation cancer patients and developed a screening sheet for domestic AYA generation cancer patients based on the NCCN® Distress Thermometer and Problem List. The NCCN® screening sheet for AYA generation cancer patients in Japan was developed based on the Distress Thermometer and Problem List, and the clinical trial to evaluate its feasibility began in January.
Clinical trials
We completed a randomized controlled study to examine the usefulness of herbal medicine yokukansan as a prophylactic medicine for postoperative delirium.
Education
We are working to develop educational programs for psycho-oncologists, pharmacists, nurses, and psychologists. In the future, we intend to establish a training system that enables doctors, psychotherapists, and other professionals involved in psychiatric oncology to learn systematically, and to contribute to the improvement of the quality of life of cancer patients in Japan by producing specialists in psychiatric oncology throughout the country.
Future prospects
We are now developing the ideal system of early palliative care for all cancer patients.
List of papers published in 2019
Journal
1. Okuyama T, Yoshiuchi K, Ogawa A, Iwase S, Yokomichi N, Sakashita A, Tagami K, Uemura K, Nakahara R, Akechi T. Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R). Oncologist, 24:e574-e582, 2019
2. Hirayama T, Ogawa Y, Yanai Y, Suzuki SI, Shimizu K. Behavioral activation therapy for depression and anxiety in cancer patients: a case series study. Biopsychosoc Med, 13:9, 2019
3. Nakaya N, Sone T, Tomata Y, Nakaya K, Hoshi M, Shimizu K, Tsuji I. All-cause mortality among Japanese whose cohabiting partners are diagnosed with cancer: the Ohsaki Cohort 2006 study. Acta Oncol, 58:425-431, 2019
4. Ishiki H, Satomi E, Shimizu K. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med, 380:1779, 2019
5. Hirano H, Shimizu C, Kawachi A, Ozawa M, Higuchi A, Yoshida S, Shimizu K, Tatara R, Horibe K. Preferences Regarding End-of-Life Care Among Adolescents and Young Adults With Cancer: Results From a Comprehensive Multicenter Survey in Japan. J Pain Symptom Manage, 58:235-243.e1, 2019
6. Wada S, Sadahiro R, Matsuoka YJ, Uchitomi Y, Yamaguchi T, Shimizu K. Yokukansan for perioperative psychiatric symptoms in cancer patients undergoing high invasive surgery. J-SUPPORT 1605 (ProD Study): study protocol for a randomized controlled trial. Trials, 20:110, 2019