Annual Report 2017

I. Department of General Internal Medicine

Ken Ohashi, Keiichiro Osame, Masaaki Shoji, Takeshi Iwasa, Keiji Okinaka, Atsushi Goto, 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 which have specialists. Lately, 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 2017, 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-

up 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 2017. Of note, we have experienced 24 cases of immune-related type 1

diabetes since 2015.

II. Department of Oncologic Emergencies

 Inanctive since April 2013.