Maiko Fujimori

No adverse effects of adjuvant chemotherapy on hippocampal volume in Japanese breast cancer survivors.

SummaryWe investigated the adverse effects of adjuvant chemotherapy on the hippocampus in Japanese breast cancer survivors with (n=44) and without (n=31) adjuvant chemotherapy. There were no significant differences in hippocampal volume (magnetic resonance imaging) or additionally in memory function (Wechsler Memory Scale-Revised) between the two groups.

Occurrence of fatigue and associated factors in disease-free breast cancer patients without depression

Goals of workStudies on fatigue in disease-free breast cancer patients have consistently found a significant association between fatigue and depression; and some characteristics of this fatigue may be confused with and/or concealed by those of depression. To clarify the characteristics of fatigue in disease-free breast cancer patients, we examined the frequency of fatigue and associated factors in disease-free breast cancer patients without major depression.Patients and methodsSeventy-nine ambulatory breast cancer patients without major depression who had been disease-free for more than 3 years since their surgery completed the Cancer Fatigue Scale (CFS), a multidimensional scale assessing cancer-related fatigue. Participants also completed the Short-form Eysenck Personality Questionnaire–Revised (EPQR) for assessing their personalities. Sociodemographic, physical, and treatment-related factors were also obtained by interview.Main resultsWe found that 36.7% of the patients exhibited fatigue and that fatigue was significantly associated with neuroticism.ConclusionsThese results suggest that a considerable number of disease-free breast cancer patients without major depression experience fatigue and that careful attention to those exhibiting high neuroticism may be of benefit in ameliorating their fatigue.

Usefulness of the nurse-assisted screening and psychiatric referral program

Major depression and adjustment disorders are common psychiatric disorders in patients with cancer, but they are often overlooked in clinical oncology settings. The nurse‐assisted screening and psychiatric referral program (NASPRP) has been introduced in clinical practice to facilitate psychiatric treatment for major depression and adjustment disorders. This study assessed the usefulness of the NASPRP and compared it with usual practice.

Depression and survival in patients with non-small cell lung cancer after curative resection : a preliminary study

Psychological depression is thought to be a predictor of poor survival among cancer patients. The objective of the present study was to investigate the association between depression and survival in surgically treated Japanese patients with non‐small cell lung cancer (NSCLC). From June 1996 through April 1999, a total of 229 patients with postoperative lung cancer were enrolled. Three months after the patients’ surgery, the Structured Clinical Interview for DSM‐III‐R (SCID) and the Profile of Mood States (POMS) were used to assess the patient for depression, based on the interviewers’ rating and a self‐report, respectively. The follow‐up period consisted of a total of 14 342 person‐months (median = 69 months). As of January 2004, 55 deaths had occurred within the follow‐up period. A Cox regression was used to estimate the hazard ratio (HR) of mortality adjusting for age, sex, smoking status, occasion of diagnosis, pathological stage and preoperative percentage forced expiratory volume in 1 s. The depression‐dejection subscale on the POMS was divided into three score levels. The multivariate HR of survival for individuals with depression, as diagnosed by the SCID, was 2.2 (95% confidence interval 0.8–6.0) (P‐value = 0.14), compared with individuals without depression. The multivariate HR of survival for subjects in the highest level of the POMS Depression–Dejection subscale was 1.4 (0.7–2.6), compared with in the lowest level (trend P‐value = 0.0502). This prospective cohort study in Japan does not support the hypothesis that depression is associated with survival among NSCLC patients after curative resection, but further analysis involving a long‐term follow‐up period is needed. (Cancer Sci 2006; 97: 199–205)

Prefrontal cortex and amygdala volume in first minor or major depressive episode after cancer diagnosis.

BACKGROUND Major and minor depressive episodes in cancer patients are frequent and are frequently seen as the first depressive episode in a patients life. However, the neurological basis of these depressive episodes remains largely unknown. METHODS Subjects were 51 breast cancer survivors (BCS) who had no history of any depressive episode before the cancer diagnosis (11 BCS with a history of a first minor depressive episode after cancer diagnosis, 11 BCS with a history of a first major depressive episode after cancer diagnosis, and 29 BCS with no history of any depressive episode after cancer diagnosis). We analyzed the prefrontal cortex (PFC) and amygdala volumes in a 1.5-Tesla Magnetic Resonance Imaging scanner. We characterized the structural correlates of depression using two complementary approaches. The first was voxel-based morphometry (VBM) that allowed us to scan the entire brain for reactive gray matter deficit. The second was classical volumetry focusing on the amygdala. RESULTS Voxel-based morphometry revealed no brain region, including PFC, for which volume was significantly different among the three groups. There were trend-level differences in the left amygdala volume in the manual tracing method among the three groups. The left amygdala volumes in the subjects with a first minor and/or major depressive episode were significantly smaller than in those with no history of any depressive episode. CONCLUSIONS It might be suggested that amygdala volume was associated with a first minor and/or major depressive episode after cancer diagnosis.

Clinical biopsychosocial risk factors for depression in lung cancer patients: a comprehensive analysis using data from the Lung Cancer Database Project

BACKGROUND Various risk factors for depression in lung cancer patients have been suggested but have been examined separately in studies with relatively small sample sizes. The present study examined the biopsychosocial risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date. PATIENTS AND METHODS A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal characteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale. RESULTS Among the recruited patients, 165 (12.4%) manifested depression. The results of a binary logistic regression analysis were significant (overall R2, 36.5%), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fighting spirit, helplessness/hopelessness, and anxious preoccupation). Although the contributions of cancer-related variables, personal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated significantly with depression. CONCLUSION Depression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.

Psychological states and coping strategies after bereavement among the spouses of cancer patients: a qualitative study

Objective: Encouraging coping strategies that contribute to positive psychological states in bereaved individuals is assumed to be desirable; however, little is known about the components of positive psychological states and bereavement‐specific coping strategies. The purpose of this study was to describe the components of psychological states and coping strategies after bereavement among the spouses of cancer patients.

Marital status, social support and survival after curative resection in non-small-cell lung cancer.

It has been suggested that marital status and social support are associated with survival in cases of lung cancer, and that such an association may be mediated by several factors. In this prospective cohort study, we investigated the effect of marital status and social support on survival after curative resection for non‐small cell lung carcinoma (NSCLC) in Japan. From June 1996 to April 1999, a total of 238 patients with resectable NSCLC were enrolled. Marital status and social support were assessed. The presence and absence of confidants and the satisfaction level with the confidants were used as factors reflecting social support. During the follow‐up period, 57 deaths from all causes were identified through January 2004. For the statistical analysis, Cox proportional hazards regression analyses were used. With regard to marital status, the multivariable adjusted hazard ratio (HR) of unmarried patients versus married patients was 0.8 (95% confidence interval, 0.3–1.8) (P‐value = 0.53) after controlling for potential confounding factors, including age, sex, occasion of cancer diagnosis, pathological stage, smoking status, smoking status after surgery and serum albumin level. Similarly, the multivariable adjusted HR of patients without confidants versus those with confidants was 1.0 (0.5–2.2) (P‐value = 0.90), whereas the multivariable adjusted HR of the dissatisfied‐with‐confidants group versus the satisfied‐with‐confidants group was 0.7 (0.4–1.3) (P‐value = 0.28). The present data do not support the hypothesis that marital status and social support are associated with survival in NSCLC. (Cancer Sci 2006; 97: 206–213)

Personality and cancer survival: the Miyagi cohort study.

We tested the hypothesis that personality plays a role in cancer outcome in a population-based prospective cohort study in Japan. In July 1990, 41 442 residents of Japan completed a short form of the Eysenck Personality Questionnaire-Revised and a questionnaire on various health habits, and between January 1993 and December 1997, 890 incident cases of cancer were identified among them. These 890 cases were followed up until March 2001, and a total of 356 deaths from all causes was identified among them. Cox proportional-hazards regression was used to estimate the hazard ratio (HR) of death according to four score levels on each of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for potential confounding factors. Multivariable HRs of deaths from all causes for individuals in the highest score level on each personality subscale compared with those at the lowest level were 1.0 for extraversion (95% CI=0.8–1.4; Trend P=0.73), 1.1 for neuroticism (0.8–1.6; Trend P=0.24), 1.2 for psychoticism (0.9–1.6; Trend P=0.29), and 1.0 for lie (0.7–1.5; Trend P=0.90). The data obtained in this population-based prospective cohort study in Japan do not support the hypothesis that personality is associated with cancer survival.

Usefulness of pharmacist-assisted screening and psychiatric referral program for outpatients with cancer undergoing chemotherapy

Objective: Major depressive disorder (MDD) and adjustment disorder (AD) are common psychiatric disorders in cancer patients but are often overlooked in clinical oncology settings. We introduced a clinical screening program utilizing the Distress and Impact Thermometer (DIT) to identify MDD and AD in cancer outpatients receiving chemotherapy. This study assessed the usefulness of the screening program.