Annual Report 2019
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, Nao Noguchi, Aki Kobayashi
Introduction
The aim of the Department of Psycho-Oncology Service is to develop mind-centered interventions to restore, maintain, and improve the quality of life of patients and their families throughout cancer treatment, and for end-of-life care. Our Service 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 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 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. Data collection of the cluster randomized controlled trial to verify the program’s effect has been completed and data is being analyzed.
2. Development of a support program for 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. 114 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. Physicians’ perceptions were compared with the 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.
We developed educational materials for nurses to provide decision support on important aspects of the treatment of elderly cancer patients.
Education
In particular, increases in the number of individuals diagnosed with cancer each year, due in large part to aging and growth of the 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 development and validation of geriatric assessment such as mini-cog, comprehensive geriatric assessment (CGA) etc., and evaluation of effectiveness of multidisciplinary intervention among hospitalized cancer patients with delirium or dementia.
List of papers published in 2019
Journal
1. Nakanishi M, Ogawa A, Nishida A. Availability of home palliative care services and dying at home in conditions needing palliative care: A population-based death certificate study. Palliat Med, 34:504-512, 2020
2. Matsuda Y, Maeda I, Morita T, Yamauchi T, Sakashita A, Watanabe H, Kaneishi K, Amano K, Iwase S, Ogawa A, Yoshiuchi K. Reversibility of delirium in Ill-hospitalized cancer patients: Does underlying etiology matter? Cancer Med, 9:19-26, 2020
3. 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, 24:e574-e582, 2019
4. Shibayama O, Yoshiuchi K, Inagaki M, Matsuoka Y, Yoshikawa E, Sugawara Y, Akechi T, Wada N, Imoto S, Murakami K, Ogawa A, Uchitomi Y. Long-term influence of adjuvant breast radiotherapy on cognitive function in breast cancer patients treated with conservation therapy. Int J Clin Oncol, 24:68-77, 2019
5. Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T. What determines the timing of discussions on forgoing anticancer treatment? A national survey of medical oncologists. Support Care Cancer, 27:1375-1382, 2019
6. Mizutani T, Nakamura K, Fukuda H, Ogawa A, Hamaguchi T, Nagashima F. Geriatric Research Policy: Japan Clinical Oncology Group (JCOG) policy. Jpn J Clin Oncol, 49:901-910, 2019
7. Hirooka K, Fukahori H, Taku K, Izawa S, Ogawa A. Posttraumatic growth in bereaved family members of patients with cancer: a qualitative analysis. Support Care Cancer, 27:1417-1424, 2019
8. 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
9. 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
10. Ishiki H, Satomi E, Shimizu K. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med, 380:1779, 2019