Toru Okuyama

Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors

PURPOSE Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. PATIENTS AND METHODS Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. RESULTS The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. CONCLUSION The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.

Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients.

We herein describe the development and validation of the Cancer Fatigue Scale (CFS) for assessment of fatigue in cancer patients. We designed this scale specifically to reflect the nature of fatigue experienced by cancer patients, by using factor analysis; the CFS is a 15-item scale composed of 3 subscales (physical, affective, and cognitive subscales). Three hundred seven cancer patients participated in the validation phase. Construct validity, confirmed by repeating factor analysis, was good. Convergent validity, confirmed by a correlation between CFS and a visual analogue scale for fatigue, was also shown to be good (r = 0.67, P < 0.001). The CFS had good stability (average test-retest reliability r = 0.69, P < 0.001) and good internal consistency (Cronbachs alpha coefficient for all 15 items = 0.88). The present study indicates that the CFS is a brief, valid, and feasible measure of fatigue for use with cancer patients.

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.

Fatigue in Ambulatory Patients with Advanced Lung Cancer: Prevalence, Correlated Factors, and Screening

Although it has been indicated that patients with lung cancer experience higher level of fatigue than patients with other cancers, few published studies have focused on the characteristics of this fatigue and how it interferes with daily activities. The purpose of this study was to clarify fatigue prevalence and the factors correlated with fatigue, and to develop a screening method for fatigue in patients with advanced lung cancer. One hundred fifty-seven patients completed two fatigue scales (Cancer Fatigue Scale [CFS], and Fatigue Numerical Scale [FNS]) plus other measures, along with a self-administered questionnaire asking whether fatigue had interfered with any of 7 areas of daily activities. Fifty-nine percent of patients had experienced clinical fatigue, which was defined as fatigue that interfered with any daily activities. Logistic regression analysis demonstrated that symptoms of dyspnea on walking, appetite loss, and depression were significant correlated factors. Both CFS and FNS were found to have sufficient sensitivity and specificity for use as a screening tool. The results indicated that fatigue is a frequent and important symptom, which is associated with both physical and psychological distress in this population. The CFS and FNS were confirmed to have sufficient screening ability.

Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer.

This study aimed to compare the impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. One hundred seventy-one outpatients with advanced lung cancer completed a questionnaire about symptom severity and whether symptoms interfered with daily life activities (normal work, walking, sleep, mood, relation with other people, enjoyment of life, and general activities). The results indicated that 1) dyspnea and fatigue interfered with at least one daily life activity in more than half the patients, and pain in about 40%, 2) dyspnea and fatigue interfered predominantly with physical activities, such as walking and work, whereas pain interfered with all activities almost equally, and 3) symptoms rated as low severity (1 to 3 on a 0-10-point numerical scale) were severe enough to interfere with at least one daily life activity. To recognize the impact of symptoms may contribute to provide better management.

Development and validation of the Cancer Dyspnoea Scale: a multidimensional, brief, self-rating scale

Dyspnoea is one of the most frequent and refractory symptoms in cancer patients. Lack of an appropriate assessment tool for dyspnoea seems to disturb establishment of management strategy. The purpose of this study was to develop and validate a brief self-rating scale to assess the multidimensional nature of dyspnoea in cancer patients. We developed a 12-item scale, the Cancer Dyspnoea Scale (CDS), composed of three factors (sense of effort/sense of anxiety/sense of discomfort), by using factor analysis. One hundred and sixty-six patients with advanced or recurrent lung cancer participated in the validation phase. The CDS showed good feasibility (average time required to complete it was 140 s). Construct validity, confirmed by repeating factor analysis, was good. Convergent validity, confirmed by a relation to Visual Analogue Scale of dyspnoea and modified Borg’s scale, was also good (average: r = 0.57 and 0.52, respectively, and both P< 0.001). The CDS had good internal consistency (average Cronbach’s alpha = 0.86) and stability (average test-retest reliability r = 0.66, P< 0.005). The present study demonstrated that the CDS is a brief, valid and feasible scale for assessing the multidimensional nature of dyspnoea in cancer patients.

Suicidality in terminally ill Japanese patients with cancer

The risk of suicide is higher in patients with cancer than in the general population, making end‐of‐life care of suicidal terminal patients with cancer critical. To identify factors and longitudinal changes associated with suicidality among terminally ill Japanese patients with cancer, a prospective cohort study was performed.

Factors Correlated with Dyspnea in Advanced Lung Cancer Patients: Organic Causes and What Else?

This study aimed to investigate factors correlated with dyspnea in cancer patients among a broad range of medico-psycho-social factors. A total of 171 consecutive outpatients with advanced lung cancer were recruited. Dyspnea was evaluated by using the Cancer Dyspnea Scale, a valid, reliable 12-item self-rating scale developed to assess the multidimensional nature of dyspnea in cancer patients. Possible correlates, including 1) medical (clinical stage, Performance Status, SpO(2), organic causes of dyspnea, other symptoms, such as cough and pain, etc.), 2) psychological (anxiety and depression), and 3) social (education, marital status, existence of confidants, etc.), factors were collected from medical charts, interviews, and self-rating questionnaires. Multiple regression analysis revealed that psychological distress, presence of organic causes, cough, and pain were significantly correlated with dyspnea (P < 0.05, multiple R(2) = 0.303). The present study confirms that dyspnea is multifactorial and that a beneficial therapeutic strategy might include intervention for psychological distress and pain.

Efficacy of methylphenidate for fatigue in advanced cancer patients: a preliminary study

Yuriko Sugawara Psycho-Oncology Division, National Cancer Center Research Institute East, 6-5-1, Kashiwanoha, Kashiwa, Chiba and Department of Psychiatry and Behavioral Science, Tokai University School of Medicine, Boseidai Isehara, Kanagawa, Tatsuo Akechi Psycho-Oncology and Psychiatry Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Yasuo Shima Palliative Care Unit, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Toru Okuyama PsychoOncology Division, National Cancer Center Research Institute East, 6-5-1, Kashiwanoha, Kashiwa, Chiba and Department of Psychiatry and Behavioral Science, Tokai University School of Medicine, Boseidai Isehara, Kanagawa, Nobuya Akizuki Psycho-Oncology and Psychiatry Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Tomohito Nakano Psycho-Oncology Division, National Cancer Center Research Institute East, 6-5-1, Kashiwanoha, Kashiwa, Chiba and Psychiatry Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo and Yosuke Uchitomi Psycho-Oncology and Psychiatry Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba

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.