Annual Report 2018

Department of General Internal Medicine / Oncologic Emergencies

Ken Ohashi, Keiichiro Osame, Masaaki Shoji, Takeshi Iwasa, 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 pre-existing medical conditions and sometimes cause these problems. These medical issues must be addressed and managed alongside the cancer itself so that our patients can benefit from optimal cancer therapies and we can improve their prognosis. The Department of General Internal Medicine was reorganized in October 2010 to better serve the diverse needs of such patients and provide more comprehensive patient-centric cancer care. Our staff have experience and expertise in their respective fields and manage these issues comprehensively.

The Team and What We Do

 We consult with cancer patients on both an inpatient and outpatient basis at the request of NCCH cancer specialists. The reasons include preoperative assessments of surgical risks, assessments 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 healthcare facilities for further evaluation or treatment. In addition, patients seen in consultation may be followed up after discharge as outpatients for the duration of their care at the NCCH.

Cardiology:

 Cardiologists oversee ECG, echocardiography, in-hospital consultations and outpatient clinics. Consultations include preoperative assessments of surgical risks, assessments of ischemic heart disease and management of arrhythmia, heart failure and other cardiological problems. We handle around 2,000 consultations a year and when emergency procedures are required, we consider transferring the patient to other facilities with specialists on hand. Recently, given the increasing number of clinical trials for cancer requiring echocardiography assessments, we make every effort to practice the test more efficiently.

Diabetology / Endocrinology:

 We provided more than 600 diabetes consultations in 2018, including perioperative management of diabetes, treatment of steroidinduced hyperglycemia during chemotherapy and so on. In many cases, initiation of insulin was the treatment of choice. We also offered close follow-up on an outpatient basis for those with diabetes during their cancer treatment at the NCCH. Alongside the expanding use of immune checkpoint inhibitors, cases of immunerelated endocrinopathies, such as type 1 diabetes, thyroiditis and hypophysitis leading to adrenal insufficiency, soared in 2018. It is noteworthy that we have experienced 30 cases of immune-related type 1 diabetes since 2015.

List of papers published in 2018

Journal

1. Sakai K, Nagashima S, Wakabayashi T, Tumenbayar B, Hayakawa H, Hayakawa M, Karasawa T, Ohashi K, Yamazaki H, Takei A, Takei S, Yamamuro D, Takahashi M, Yagyu H, Osuga JI, Takahashi M, Tominaga SI, Ishibashi S. Myeloid HMG-CoA (3-Hydroxy-3-Methylglutaryl-Coenzyme A) Reductase Determines Atherosclerosis by Modulating Migration of Macrophages. Arterioscler Thromb Vasc Biol, 38:2590-2600, 2018