Annual Report 2021
Division of Psycho-Oncology
Asao Ogawa, Masanori Enokido, Yusei Iwata, Yoshihisa Matsumoto, Saaya Soejima, Yurika Nakamura, Rina Murakami, Nanao Sayama, Kiyoko Otani, Yasuko Uchimura, Nao Noguchi, Kana Toyonaga, Masako Ikeda
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 for end-of-life care. 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.
Research activities
1) Development of a multidisciplinary management program for delirium
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. The primary prevention, preventing delirium before it develops, is the most effective strategy for reducing delirium. We evaluated whether the DELirium Team Approach (DELTA) program-a systematic management program aimed at screening high-risk groups and preventing delirium-would improve quality of care in patients hospitalized with cancer. A retrospective before-after study was conducted during a pre-intervention period and a post-intervention period at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation. After program implementation, the incidence of delirium decreased from 7.1% to 4.3% (odds ratio [OR]: 0.52; 95% CI: 0.42-0.64). The incidence of adverse events, including falls or self-extubation, also decreased. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards. Data collection of the cluster randomized controlled trial to verify the program’s effect has been completed and data is being analyzed.
2) Development of a support program for people with dementia in acute hospital settings as a multidisciplinary approach
To assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians’ perceptions of patients’ decision-making capacity, we recruited 122 newly diagnosed patients with lung cancer. 114 completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Physicians’ perceptions were compared with the ascertainments. Twenty-seven (24%; 95% confidence interval [CI]: 16 to 31) patients were judged to have incapacity. Logistic regression identified frailty (odds ratio: 3.51; 95% CI: 1.13 to 10.8) and cognitive impairment (odds ratio: 5.45; 95% CI: 1.26 to 23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients.
We developed educational materials for nurses to provide decision support on important aspects of the treatment of elderly cancer patients.
Education
In particular, increases in the number of individuals diagnosed with cancer each year, due in large part to aging and growth of the population, as well as improving survival rates, have led to an ever-increasing number of elderly cancer patients with deterioration of cognitive function. Thus, we conduct research into development and validation of geriatric assessment such as mini-cog, comprehensive geriatric assessment (CGA), etc., and evaluation of effectiveness of multidisciplinary intervention among hospitalized cancer patients with delirium or dementia.
List of papers published in 2021
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. Matsuda Y, Yamaguchi T, Matsumoto Y, Ishiki H, Usui Y, Kako J, Suzuki K, Matsunuma R, Mori M, Watanabe H, Zenda S. Research policy in supportive care and palliative care for cancer dyspnea. Japanese journal of clinical oncology, 52:260-265, 2022
3. Usui Y, Miura T, Kawaguchi T, Kosugi K, Uehara Y, Kato M, Kosugi T, Sone M, Nakamura N, Mizushima A, Miyashita M, Morita T, Yamaguchi T, Matsumoto Y, Satomi E. Palliative care physicians' recognition of patients after immune checkpoint inhibitors and immune-related adverse events. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 30:775-784, 2022
4. Sakata N, Okumura Y, Ogawa A. Postoperative Pain Treatment in Patients with Dementia: A Retrospective Observational Study. Drugs & aging, 39:305-311, 2022
5. 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
6. Miura T, Elgersma R, Okizaki A, Inoue MK, Amano K, Mori M, Chitose H, Matsumoto Y, Jager-Wittenaar H, Ottery FD . A Japanese translation, cultural adaptation, and linguistic and content validity confirmation of the Scored Patient-Generated Subjective Global Assessment. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 29:7329-7338, 2021
7. 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
8. Suzuki K, Ikari T, Matsunuma R, Matsuda Y, Matsumoto Y, Miwa S, Mori M, Yamaguchi T, Watanabe H, Tanaka K. The Possibility of Conducting a Clinical Trial on Palliative Care: A Survey of Whether a Clinical Study on Cancer Dyspnea Is Acceptable to Cancer Patients and Their Relatives. Journal of pain and symptom management, 62:1262-1272, 2021
9. 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
10. 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
11. 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
12. 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
13. Maeda I, Satomi E, Kiuchi D, Nishijima K, Matsuda Y, Tokoro A, Tagami K, Matsumoto Y, Naito A, Morita T, Iwase S, Otani H, Odagiri T, Watanabe H, Mori M, Matsuda Y, Nagaoka H, Mayuzumi M, Kanai Y, Sakamoto N, Ariyoshi K. Patient-perceived symptomatic benefits of olanzapine treatment for nausea and vomiting in patients with advanced cancer who received palliative care through consultation teams: a multicenter prospective observational study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 29:5831-5838, 2021
14. Kosugi K, Nishiguchi Y, Miura T, Fujisawa D, Kawaguchi T, Izumi K, Takehana J, Uehara Y, Usui Y, Terada T, Inoue Y, Natsume M, Yajima MY, Watanabe YS, Okizaki A, Matsushima E, Matsumoto Y. Association Between Loneliness and the Frequency of Using Online Peer Support Groups Among Cancer Patients With Minor Children: A Cross-Sectional Web-Based Study. Journal of pain and symptom management, 61:955-962, 2021