Annual Report 2022
Division of Psycho-Oncology
Asao Ogawa, Masanori Enokido, Yusei Iwata, Tomofumi Miura, Saaya Soejima, Rina Murakami, Nanao Sayama, Kiyoko Otani, Yasuko Uchimura, Kana Toyonaga, Masako Ikeda, Yumiko Ojima, Hitomi Minami, Kanako Tokuma
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 for end-of-life care. The 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.
As for clinical research, Ramelteon for prevention of postoperative delirium in delirium high-risk cancer patients.: A randomized, double-blind, placebo-controlled multi-center trial is being conducted in collaboration with the National Cancer Center Hospital and NHO Kinki-Chuo Chest Medical Center, and cases are currently being accumulated.
Research Activities
1) Development of 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 older persons. Primary prevention, i.e., 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 the quality of care in patients hospitalized with cancer. A retrospective before–after study was conducted during a pre- and 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 the program implementation, the incidence of delirium decreased from 7.1% to 4.3% (odds ratio [OR], 0.52; 95% confidence interval [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 has been completed and data is being analyzed to verify the program effect.
2) Development of a support program for patients with dementia in acute hospital settings as a multidisciplinary approach
The objective is to assess the 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). The decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Physicians’ perceptions were compared with the ascertainments. Twenty-seven (24%, 95% CI, 16–31) patients were judged to have incapacity. Logistic regression identified frailty (OR, 3.51; 95% CI, 1.13–10.8) and cognitive impairment (OR, 5.45; 95% CI, 1.26–23.6) 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 medical decisions. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of the patients.
We developed educational materials for nurses to provide decision support in the important aspects of the treatment for elderly cancer patients.
Education
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 cognitive function deterioration. 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 interventions among hospitalized cancer patients with delirium or dementia.
Future Prospects
With the implementation of the Fourth Basic Plan to Promote Cancer Control Programs, palliative care and support for survivors of cancer are also required to be more implementation-oriented. In this area as well, we would like to use the characteristics of our country to promote proposals that contribute to the improvement of the quality of medical care.