Annual Report 2017

Division of Psycho-Oncology

Asao Ogawa, Ken Shimizu, Yoshihisa Matsumoto, Masanori Enokido, Yusei Iwata, Yudai Saga, Yusuke Kanno, Masataka Furukawa, Tomoko Nishimura, Saaya Soejima, Nanao Sayama, Kiyoko Otani, Yasuko Uchimura, Kana Toyonaga, Masako Ikeda

Introduction

 The aim of the Division of Psycho-Oncology is to develop mind-centered interventions to restore, maintain, and improve the quality of life of patients and their families throughout cancer treatment, and in end-of-life care. Our division 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 4,180 inpatients were evaluated before the implementation of the DELTA program and 3,797 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.

2. Development of the support program for the 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. One hundred fourteen patients 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 (MacCAT-T). Physicians' perceptions were compared with 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.

Future prospects

 Especially, increases in the number of individuals diagnosed with cancer each year, due in large part to the growth of the aging 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 the development and validation of geriatric assessment such as Mini-Cog, comprehensive geriatric assessment (CGA) and so on, and the evaluation of effectiveness of multidisciplinary intervention among hospitalized cancer patients with delirium or dementia.

List of papers published in January 2017 - March 2018

Journal

1. Matsuo N, Morita T, Matsuda Y, Okamoto K, Matsumoto Y, Kaneishi K, Odagiri T, Sakurai H, Katayama H, Mori I, Yamada H, Watanabe H, Yokoyama T, Yamaguchi T, Nishi T, Shirado A, Hiramoto S, Watanabe T, Kohara H, Shimoyama S, Aruga E, Baba M, Sumita K, Iwase S. Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study. J Palliat Med, 20:352-359, 2017

2. Mori M, Shirado AN, Morita T, Okamoto K, Matsuda Y, Matsumoto Y, Yamada H, Sakurai H, Aruga E, Kaneishi K, Watanabe H, Yamaguchi T, Odagiri T, Hiramoto S, Kohara H, Matsuo N, Katayama H, Nishi T, Matsui T, Iwase S. Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study. Support Care Cancer, 25:1169-1181, 2017

3. Yamada T, Morita T, Maeda I, Inoue S, Ikenaga M, Matsumoto Y, Baba M, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Tatara R, Watanabe H, Otani H, Takigawa C, Matsuda Y, Ono S, Ozawa T, Yamamoto R, Shishido H, Yamamoto N. A prospective, multicenter cohort study to validate a simple performance status-based survival prediction system for oncologists. Cancer, 123:1442-1452, 2017

4. Hirooka K, Fukahori H, Taku K, Togari T, Ogawa A. Quality of death, rumination, and posttraumatic growth among bereaved family members of cancer patients in home palliative care. Psychooncology, 26:2168-2174, 2017

5. Kako J, Kobayashi M, Kanno Y, Tagami K. Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient With Advanced Cancer Undergoing Palliative Care. J Pain Symptom Manage, 54:e2-e4, 2017

6. Wada S, Inoguchi H, Hirayama T, Matsuoka YJ, Uchitomi Y, Ochiai H, Tsukamoto S, Shida D, Kanemitsu Y, Shimizu K. Yokukansan for the treatment of preoperative anxiety and postoperative delirium in colorectal cancer patients: a retrospective study. Jpn J Clin Oncol, 47:844-848, 2017

7. Sakata N, Okumura Y, Fushimi K, Nakanishi M, Ogawa A. Dementia and Risk of 30-Day Readmission in Older Adults After Discharge from Acute Care Hospitals. J Am Geriatr Soc, 66:871-878, 2018

8. Ogawa A, Kondo K, Takei H, Fujisawa D, Ohe Y, Akechi T. Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer. Oncologist, 23:489-495, 2018

9. Hirooka K, Fukahori H, Taku K, Togari T, Ogawa A. Examining Posttraumatic Growth Among Bereaved Family Members of Patients With Cancer Who Received Palliative Care at Home. Am J Hosp Palliat Care, 35:211-217, 2018