Department of General Internal Medicine / Oncologic Emergencies

I. Department of General Internal Medicine

Ken Ohashi, Hisashi Baba, Keiichiro Osame, Masaaki Shoji, Takeshi Iwasa, Keiji Okinaka, Yukiko Okazaki

Introduction

The increasing number of cancer patients who visit the National Cancer Center Hospital (NCCH) 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 cancer care. Our staff have experience and expertise in their respective fields and provide comprehensive management of these issues.

Our team and what we do

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.

Cardiology:

Cardiologists take charge of electrocardiogram (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 emergency procedure is necessary, we consider transferring patients 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.

Diabetology / Endocrinology:

We provided more than 600 diabetes consultations in 2016, which include perioperative management of diabetes, treatment of steroid-induced hyperglycemia during chemotherapy, and so on. 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. Along with the expanding use of immune checkpoint inhibitors, cases of immune-related endocrinopathies, such as type 1 diabetes, thyroiditis, and hypophysitis leading to adrenal insufficiency, increased dramatically in 2016.

Infectious diseases:

An infectious disease (ID) specialist has provided about 400 consultations including active interventions triggered by positive blood culture. An ID physician has also been 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.

II. Department of Oncologic Emergencies

Inactive since April 2013.

List of papers published in 2016

Journal

1.Iwasa T, Amiya E, Ando J, Watanabe M, Murasawa T, Komuro I. Different Contributions of Physical Activity on Arterial Stiffness between Diabetics and Non-Diabetics. PLoS One, 11:e0160632, 2016

2.Ueki K, Sasako T, Kato M, Okazaki Y, Okahata S, Katsuyama H, Haraguchi M, Morita A, Ohashi K, Hara K, Morise A, Izumi K, Ohashi Y, Noda M, Kadowaki T, J-DOIT3 Study Group. Design of and rationale for the Japan Diabetes Optimal Integrated Treatment study for 3 major risk factors of cardiovascular diseases (J-DOIT3): a multicenter, open-label, randomized, parallel-group trial. BMJ Open Diabetes Res Care, 4:e000123, 2016

3.Inada S, Yoshiuchi K, Iizuka Y, Ohashi K, Kikuchi H, Yamamoto Y, Kadowaki T, Akabayashi A. Pilot Study for the Development of a Self-Care System for Type 2 Diabetes Patients Using a Personal Digital Assistant (PDA). Int J Behav Med, 23:295-299, 2016

4.Goto A, Noto H, Noda M, Ueki K, Kasuga M, Tajima N, Ohashi K, Sakai R, Tsugane S, Hamajima N, Tajima K, Imai K, Nakagama H. Report of the Japan diabetes society/Japanese cancer association joint committee on diabetes and cancer, Second report. Cancer Sci, 107:369-371, 2016