Ichiro Mikami

Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale

Abstract Fatigue is one of the most frequent symptoms in cancer patients. However, the precise causes of this fatigue are still unknown, and this situation makes it difficult to combat the problem. The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients. A group of 134 randomly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated. They completed the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale, the Mental Adjustment to Cancer Scale, and an ad hoc questionnaire detailing physical symptoms, social support, and demographic variables at home and returned them by mail the following day. Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea, insufficient sleep, and depression, and that these three variables accounted for a total of 46% of variance in fatigue. Factors concerned with the cancer and treatment, such as disease stage, lymph node metastasis, number of days since operation, past intravenous chemotherapy, radiotherapy, current use of fluoropyrimidine compounds, and current use of tamoxifen citrate were not correlated with fatigue. The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments, and that the management of dyspnea, insomnia, and depression might be important in reducing fatigue in this population.

Depression and Psychological Distress in Patients During the Year After Curative Resection of Non–Small-Cell Lung Cancer

PURPOSE There have been few psychosocial studies of patients after curative resection of non-small-cell lung cancer (NSCLC). The purpose of this study was to clarify the clinical course of depression and psychological distress of such patients during the year after surgery and to identify predictors of their long-term outcome. PATIENTS AND METHODS A total of 212 patients completed assessments during a 12-month follow-up period after curative resection of NSCLC. Psychological measurements at 1, 3, and 12 months after surgery were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (ed 3), Revised, and the Profiles of Mood States (POMS) scale. Univariate and multivariate analyses were used to identify predictors of psychological outcome according to these two methods of assessment. RESULTS The prevalence of depression did not change during the year after curative resection (range, 4.7% to 8.0%). The total POMS score was also unaltered during the year after surgery: the anger-hostility (P <.001) and tension-anxiety subscale scores (P <.026) had increased at 12 months, but the vigor-activity subscale score had also increased (P <.001). All predictors of psychological outcome at 12 months included a depression episode after the diagnosis of lung cancer or at 1 month after surgery. Less-educated status was also a significant predictor of depression at 12 months. CONCLUSION These results suggest the need for psychosocial support even after curative resection of NSCLC and indicate that an approach that includes repetitive perioperative assessment of depression and careful attention to less-educated patients might be of benefit to patients in ameliorating depression and psychological distress during the year after curative resection.

Correlates of depressed mood in ambulatory head and neck cancer patients.

High levels of psychological distress, especially depressed mood, has been discussed in relation to head and neck cancer. Patients with head and neck cancer face functional impairment and disfigurement caused by cancer and/or its treatment. Psychosocial factors that predict depressed mood in this population have not been well elucidated. The aim of this study is to examine the psychosocial and medical risk factors for depressed mood in ambulatory head and neck cancer patients. Depressed mood and coping style were assessed with the Profile of Mood States (POMS) and the Mental Adjustment to Cancer (MAC) scales, respectively, in 99 ambulatory head and neck cancer patients. Simultaneously, patients’ social support and satisfaction with it, and sociodemographic and medical data were obtained. Multiple regression analysis revealed that advanced disease, being unmarried, and helpless/hopeless coping were significantly associated with depressed mood. The results suggest that we should identify these factors and target psychosocial intervention for those patients most at risk. Copyright

Suicidal thoughts in cancer patients: Clinical experience in psycho‐oncology

Because cancer is a life‐threatening illness, its impact on the patient’s emotional well‐being, such as suicidal thoughts, has become a significant problem in public health as well as in clinical oncology. Factors such as the pain and hopelessness are suggested as making cancer patients more vulnerable to suicide. On the other hand, euthanasia and physician‐assisted suicide are now important medical and social issues all over the world. However, little is known about the relationship between the characteristics of cancer patients and suicidal thoughts. The present study investigated the characteristics of patients who were referred to the Psychiatry Division, National Cancer Center Hospital East, due to risk of suicide or suicide attempts. Fourteen patients were referred, representing 3.9% of all consultations. Most of these patients suffered from advanced cancer and poor physical functioning. The most frequent psychiatric diagnosis was mood disorder (57%), and the next was delirium (29%). In patients with mood disorders (8 cases), suicidal thoughts disappeared after psychiatric treatment in 5 cases, but not in 3 cases. Those three patients survived a significantly shorter time than the others after psychiatric consultation. These empirical data might indicate that most suicidal thoughts experienced by cancer patients are not rational, and a careful evaluation, including psychiatric assessment, should be conducted in such patients.

A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence

Goals of workThe effects of psychosocial group interventions on improving quality of life (QOL) for patients with recurrent breast cancer are not well known. The objective of this study was to assess the feasibility of a psychosocial group intervention in Japanese women with first recurrence of breast cancer.Patients and methodThe subjects were consecutively selected from among patients who were diagnosed with a first recurrence of breast cancer. We conducted a 6-week psychosocial group intervention. QOL was assessed using the Profile of Mood States (POMS), the Impact of Event Scale—Revised, the Mental Adjustment to Cancer (MAC) scale, and the European Organization for Research and the Treatment of Cancer (EORTC) Quality of Life Questionnaire—Cancer 30/Breast module 23 (QLQ-C30/Br23) at baseline then immediately and 3 and 6 months after completion of the intervention.ResultsAmong 58 eligible patients, written consent was obtained from 28 (48%), and the final evaluation was conducted on 19 subjects. The repeated measured analysis of variance (ANOVA) revealed a significant change in tension–anxiety, depression–dejection, anger–hostility and total mood disturbance on the POMS, helplessness/hopelessness on the MAC scale, and body image and future perspective on the QLQ-C30/Br23. Dunnett’s test revealed a significant difference in these scores between baseline and 3 months after the intervention but no difference between baseline and 6 months after the intervention.ConclusionThese results suggested the possibility of a short-term effectiveness of the intervention; however the results were inconclusive because of selected small samples.

Depression in Patients with Advanced Cancer

Prevalence and risk factors for depression, desire for death, and diagnosing depression were examined in patients with advanced cancer. 1) Of 141 subjects, 44 patients diagnosed with recurrent breast cancer and 97 with advanced non-small-cell lung cancer, 43.2% of those with recurrent breast cancer and 14.4% of those with advanced non-small-cell lung cancer met the DSM-III-R criteria for adjustment disorder or major depression. Logistic regression analysis showed that a disease-free interval less than 24 months in recurrent breast cancer and low fighting spirit, family history of cancer death, past history of depression and dissatisfaction with confidants in non-small-cell lung cancer significantly predicted a diagnosis of adjustment disorder or major depression. These results indicate that psychosocial interventions are necessary for patients with advanced cancer who have risk factors for depression. 2) All of 5 patients with terminal cancer who expressed a desire for death were diagnosed with major depression according to DSM-III-R. After treatment with tricyclic antidepressants, they all showed remarkable improvement of depressed mood and their desire for death had almost disappeared. These experiences suggest that appropriate treatment of depression may alter the desire for death in terminally ill cancer patients. However, depression is frequently underdiagnosed and undertreated because the diagnostic criteria of major depression include physical symptoms normally observed during the course of cancer and/or cancer treatment. We propose using a biological marker (serotonin2A receptor-mediated Ca2+ response in human platelets) as one of the adjuncts in diagnosing depression in cancer patients.