Annual Report 2018
Division of Psycho-Oncology
Asao Ogawa, Ken Shimizu, Yoshihisa Matsumoto, Masanori Enokido, Yusei Iwata, Masataka Furukawa, Saaya Soejima, Akiko Netsu, Riho Ogihara, Nanao Sayama, Kiyoko Otani, Yasuko Uchimura, Kana Toyonaga, Masako Ikeda
Introduction
The Division aims to develop mind-centric interventions to restore, maintain and improve the quality of life of patients and their families throughout cancer treatment and for end-of-life care. The Division has focused on developing effective interventions for delirium, dementia and depression in cancer patients as well as determining the mechanism underlying the relationship between cancer and the mind by combining 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 the global cognitive function, is a common, serious and potentially preventable source of morbidity and mortality for hospitalized elderly persons. 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 highrisk groups and preventing delirium-would improve quality of care in patients hospitalized with cancer. A retrospective before-after study was conducted during pre- and post-intervention periods at a Japanese hospital providing specialized cancer treatment. A total of 4,180 inpatients were evaluated before implementing the DELTA program and 3,797 inpatients after. After implementing the program, the incidence of delirium decreased from 7.1% to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42-0.64) and the incidence of adverse events, including falls or self-extubation, also declined. These data suggest that this simple cost-effective program is feasible and implementable as a means of routine care in busy wards. The registration of a cluster randomized controlled trial to verify the program effect is complete and data is being collected.
2. Development of a support program for people with dementia in acute hospital settings as part of 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' decisionmaking capacity.
We recruited 122 newly diagnosed patients with lung cancer, 114 of whom completed the assessment. All patients were receiving a combination of treatments (e.g. chemotherapy, chemo-radiotherapy, or targeted therapy). Their decision-making capacity was assessed using the MacArthur Competence Tool for Treatment and physicians' perceptions were compared with the ascertainments. Twenty-seven (24%, 95% confidence interval [CI], 16 to 31) patients were judged as having an 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, but A substantial proportion of patients diagnosed with lung cancer showed an impaired capacity for medical decision-making. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients.
The development of educational materials for nurses is currently being considered to provide decision-making support for important aspects of treating elderly cancer patients.
Future prospects
In particular, more and more individuals diagnosed with cancer each year, due largely to aging and population growth, as well as improving survival rates, have led to an everincreasing number of elderly cancer patients with deterioration of cognitive function. Accordingly, we conduct research into developing and validating geriatric assessments such as minicog, comprehensive geriatric assessments (CGAs) et al. and evaluation of effectiveness for multidisciplinary intervention among hospitalized cancer patients with delirium or dementia.
List of papers published in 2018
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, 2019
2. 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
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. Wada S, Inoguchi H, Sadahiro R, Matsuoka YJ, Uchitomi Y, Sato T, Shimada K, Yoshimoto S, Daiko H, Shimizu K. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study. World J Surg, 43:134-142, 2019
5. Ogawa A, Okumura Y, Fujisawa D, Takei H, Sasaki C, Hirai K, Kanno Y, Higa K, Ichida Y, Sekimoto A, Asanuma C. Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial. Support Care Cancer, 27:557-565, 2019
6. Watanabe YS, Miura T, Okizaki A, Tagami K, Matsumoto Y, Fujimori M, Morita T, Kinoshita H. Comparison of Indicators for Achievement of Pain Control With a Personalized Pain Goal in a Comprehensive Cancer Center. J Pain Symptom Manage, 55:1159-1164, 2018
7. Ishiki H, Yamaguchi T, Matsumoto Y, Kiuchi D, Satomi E. Effect of early palliative care: complex intervention and complex results. Lancet Oncol, 19:e221, 2018
8. Kako J, Kobayashi M, Kanno Y, Ogawa A, Miura T, Matsumoto Y. The Optimal Cutoff Point for Expressing Revised Edmonton Symptom Assessment System Scores as Binary Data Indicating the Presence or Absence of Symptoms. Am J Hosp Palliat Care, 35:1390-1393, 2018
9. Tagami K, Okizaki A, Miura T, Watanabe YS, Matsumoto Y, Morita T, Fujimori M, Kinoshita H. Breakthrough Cancer Pain Influences General Activities and Pain Management: A Comparison of Patients with and without Breakthrough Cancer Pain. J Palliat Med, 21:1636-1640, 2018
10. Hamano J, Takeuchi A, Yamaguchi T, Baba M, Imai K, Ikenaga M, Matsumoto Y, Sekine R, Yamaguchi T, Hirohashi T, Tajima T, Tatara R, Watanabe H, Otani H, Nagaoka H, Mori M, Tei Y, Hiramoto S, Morita T. A combination of routine laboratory findings and vital signs can predict survival of advanced cancer patients without physician evaluation: a fractional polynomial model. Eur J Cancer, 105:50-60, 2018
11. Miura T, Amano K, Shirado A, Baba M, Ozawa T, Nakajima N, Suga A, Matsumoto Y, Shimizu M, Shimoyama S, Kuriyama T, Matsuda Y, Iwashita T, Mori I, Kinoshita H. Low Transthyretin Levels Predict Poor Prognosis in Cancer Patients in Palliative Care Settings. Nutr Cancer, 70:1283-1289, 2018
12. Yoshida S, Ogawa C, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y, Dotani C, Nakahara R, Kato M. Japanese physicians' attitudes toward end-of-life discussion with pediatric patients with cancer. Support Care Cancer, 26:3861-3871, 2018
13. 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
14. Nakanishi M, Okumura Y, Ogawa A. Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals. Int Psychogeriatr, 30:991- 1000, 2018
15. 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
16. Kaibori M, Nagashima F, Ogawa A. Resection versus radiofrequency ablation for hepatocellular carcinoma in elderly patients in a Japanese nationwide cohort. Ann Surg