Annual Report 2023
Department of General Internal Medicine
Department of Cardiology: Masaaki Shoji, Takeshi Iwasa
Department of Diabeto-oncology / Endocrinology: Ken Ohashi, Keiichiro Osame, Yukiko Okazaki, Atsushi Goto, Masaki Uchihara
Introduction
The increasing number of cancer patients who visit the National Cancer Center Hospital 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 better outcomes. 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 members have experience and expertise in their respective fields and provide comprehensive management of these issues.
The 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 referrals 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.
Department of Cardiology Introduction
The Department of Cardiology deals with cardiovascular disease (heart disease and vascular disease). The subjects are ischemic heart diseases (angina and myocardial infarction), arrhythmia, cardiomyopathy, valvular heart disease, lower limb arteriovenous thrombosis and the like. Mainly, the heart condition during the perioperative period or chemotherapy is evaluated by using an electrocardiogram and echocardiography, and the heart is managed so that the cancer patient can receive the best treatment. Cardiovascular disease can be suddenly life-threatening and may require urgent treatment. In such a case, we cooperate with neighboring hospitals that can provide emergency treatment such as catheter treatment and highly intensive treatment. In recent years, Onco-Cardiology has been prospering as an interdisciplinary area connecting the tumor and cardiovascular fields. We are also studying the effects of anticancer agents on cardiac function and venous thrombosis, which is often found in cancer patients.
Future Prospects
In the future, we plan to further advance the current research. Especially for venous thrombosis, a new anticoagulant (NOAC) has started to be indicated and is expected to replace the conventionally used warfarin, so it is important to investigate its efficacy and safety in cancer patients. Although some data are collected from this hospital, it is necessary to carry out research jointly with other institutions. J-COSMOS (Japanese Cardio-Oncology network for Scientific Methodologies to improve the Outcome of cancer Survivors), which we are also involved in as an executive committee, is the field of Onco-Cardiology for all-Japan basic research, clinical research, and epidemiological research.
Department of Diabeto-oncology / Endocrinology:
We have provided more than 750 diabetes consultations in 2023, which include perioperative management of diabetes and treatment of steroid-induced hyperglycemia during chemotherapy. In many cases, the 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 (Fig1), thyroiditis, and hypophysitis leading to adrenal insufficiency, have increased dramatically in 2022 and continued to occur in 2023. To respond to the increasing needs of consultations related to hormone-producing adrenal cancers and pheochromocytoma/paraganglioma, we have launched the Onco-Endocrinology Clinic in June 2021.
Figure 1. Number of cases with immune-checkpoint inhibitor-induced type 1 diabetes
List of papers published in 2023
Journal
1. Goto A, Ohashi K, Noda M, Noto H, Ueki K, Inoue M, Nishimura R, Takahashi S, Ioka T, Oshima M, Fujibayashi K, Tsuji A, Kodaira M, Tamakoshi A, Mimori K, Tanabe Y, Hara E, Matsuo K, Murakami Y, Watada H. Third Report of the Japan Diabetes Society/Japanese Cancer Association Joint Committee on Diabetes and Cancer: Summary of the results of a questionnaire survey of oncologists and diabetologists-Secondary publication. Cancer science, 115:672-681, 2024
2. Shoji M, Yamashita Y, Ishii M, Inoue H, Kato H, Fujita S, Matsui K, Tajiri K, Nameki M, Muraoka N, Nonaka A, Sugino H, Kono M, Oka T, Sueta D, Komuro I, Tsujita K. A Predictive Model for Cancer-Associated Thrombosis in Japanese Cancer Patients: Findings from the J-Khorana Registry. TH open, 8:e9-e18, 2024
3. Goto A, Ohashi K, Noda M, Noto H, Ueki K, Inoue M, Nishimura R, Takahashi S, Ioka T, Oshima M, Fujibayashi K, Tsuji A, Kodaira M, Tamakoshi A, Mimori K, Tanabe Y, Hara E, Matsuo K, Murakami Y, Watada H. Third Report of the Japan Diabetes Society (JDS)/Japanese Cancer Association (JCA) Joint Committee on diabetes and cancer: summary of the results of a questionnaire survey of oncologists and diabetologists-secondary publication. Diabetology international, 15:5-18, 2024
4. Sueta D, Yamashita Y, Morimoto T, Muraoka N, Umetsu M, Nishimoto Y, Takada T, Ogihara Y, Nishikawa T, Ikeda N, Otsui K, Tsubata Y, Shoji M, Shikama A, Hosoi Y, Tanabe Y, Chatani R, Tsukahara K, Nakanishi N, Kim K, Ikeda S, Mo M, Kimura T, Tsujita K. The impact of renal function on clinical outcomes of patients with cancer-associated isolated distal deep vein thrombosis: Insights from the ONCO DVT study. Thrombosis research, 235:107-115, 2024
5. Chatani R, Yamashita Y, Morimoto T, Muraoka N, Shioyama W, Shibata T, Nishimoto Y, Ogihara Y, Doi K, Oi M, Shiga T, Sueta D, Kim K, Tanabe Y, Koitabashi N, Takada T, Ikeda S, Nakagawa H, Mitsuhashi T, Shoji M, Sakamoto J, Hisatake S, Ogino Y, Fujita M, Nakanishi N, Dohke T, Hiramori S, Nawada R, Kaneda K, Mushiake K, Yamamoto H, Kadota K, Ono K, Kimura T. Home Treatment for Active Cancer Patients With Low-Risk Pulmonary Embolism - A Predetermined Companion Report From the ONCO PE Trial. Circulation journal, 2024
6. Yamashita Y, Morimoto T, Muraoka N, Oyakawa T, Umetsu M, Akamatsu D, Nishimoto Y, Sato Y, Takada T, Jujo K, Minami Y, Ogihara Y, Dohi K, Fujita M, Nishikawa T, Ikeda N, Hashimoto G, Otsui K, Mori K, Sueta D, Tsubata Y, Shoji M, Shikama A, Hosoi Y, Tanabe Y, Chatani R, Tsukahara K, Nakanishi N, Kim K, Ikeda S, Mo M, Yoshikawa Y, Kimura T. Edoxaban for 12 Months Versus 3 Months in Patients With Cancer With Isolated Distal Deep Vein Thrombosis (ONCO DVT Study): An Open-Label, Multicenter, Randomized Clinical Trial. Circulation, 148:1665-1676, 2023