There are several delirium subtypes, and the disorder is now classified into three main subtypes as follows: hyperactive, hypoactive, and mixed. Hypoactive delirium, which is characterized by sluggishness and lethargy, is the most common type, and is also associated with profound distress in patients with cancer and their families although extreme agitation is not observed in hypoactive delirium The treatment of delirium generally includes the identifying and addressing of underlying causes and the concurrent management of delirium symptoms using both non-pharmacological and pharmacological strategies However, no standard management strategies exist, and there is a particular lack of evidence of effective pharmacotherapies, for hypoactive delirium.
Previous epidemiological studies and meta-analyses show that the suicide rate of patients with cancer is approximately twice as high as that of the general population 20 , Findings of recent studies support this pattern. For example, one Western study that investigated the effect of cancer diagnosis found that diagnosis can produce acute stress associated with higher suicide rates, particularly in the first weeks, and that these effects last for at least 6 months after cancer diagnosis 22 , In addition, a Japanese study we conducted revealed that the suicide rate for people within 1 year of a cancer diagnosis is more than 20 times higher than that for people not diagnosed with cancer These studies suggest that intervention immediately after cancer diagnosis is critical for preventing suicide among patients with cancer.
However, the underlying reasons as to why patients with cancer are more likely to commit suicide very soon after cancer diagnosis are not clearly understood. Furthermore, previous studies consistently indicate that males, patients suffering from advanced stage cancer at the time of diagnosis, and patients with head and neck cancer are more likely to commit suicide 24 , As mentioned above, another common risk factor of suicide is being in the first 2 or 3 months after a cancer diagnosis 21 , 25 , Remarkably, psychological autopsy studies of patients with cancer who committed suicide suggest that the most frequent underlying cause is depression, not physical pain Filiberti et al.
They found that majority of the patients had experienced both physical suffering and psychological distress, including depression. They indicate that all the patients experienced the loss of autonomy and independence and refused to be a burden to others Some researchers claim that there may be a rational basis to suicide among some patients with terminal cancer Compared with other developed countries, Japan has a remarkably high suicide rate.
Some researchers have proposed that core cancer hospitals should conduct research on suicide prevention and that psycho-oncology experts could play an important role in suicide prevention efforts in Japan During the illness trajectory, most patients with cancer experience several kinds of physical distress.
Some of these symptoms are closely associated with psychological function. More than half of patients with cancer experience pain during their illness trajectory.
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Appropriate pain management should include both analgesia and individualized psychosocial care that focuses on patients' psychological experiences of pain. There are numerous opportunities to offer patients with cancer multidisciplinary treatment for pain management, and multidisciplinary teams usually include mental health professionals who have a good understanding of the multifaceted aspects of pain. Pain and psychological distress, including anxiety and depression, have a bidirectional association What kind of approach is required to appropriately assess and manage patients with cancer who suffer from pain?
Psycho-oncology: History, Current Status, and Future Directions in Japan | JMA Journal
When pain is clearly caused by the progression of advanced cancer, drugs such as non-steroidal anti-inflammatory analgesics, weak opioids, and strong opioids are used, as appropriate, in pharmacological therapy. In the case of neuropathic pain, which is often refractory to the usual pharmacotherapies, psychotropic agents such as antidepressants and anticonvulsants are often used in combination with the above-mentioned drugs These administrative methods are described in the World Health Organization's cancer pain treatment ladder Cancer pain has mostly physical causes, but chronic pain in cancer survivors who do not have active cancer has gained recent attention.
These patients are also likely to have psychiatric problems, such as anxiety and depression. Therefore, psycho-oncologists play an important role in evaluating concurrent psychosocial issues and advising patients how to manage them. Numerous patients feel that the development of pain is a sign of recurrent cancer or disease progression.
In such cases, in addition to alleviating the physical pain, psychological support is crucial. In such cases, the expression of pain may be amplified because of the lack of emotional suppression owing to delirium. Nausea and vomiting that often accompany later cancer treatments start even prior to the administration of the chemotherapeutic agent; this phenomenon has been defined as anticipatory nausea and vomiting ANV ANV can best be understood in terms of classical conditioning. Typically, ANV is a learned response to one or more distinctive features of the chemotherapy clinic conditioned stimuli associated with the administration of emetogenic chemotherapy unconditioned stimuli For example, earlier studies of patient perceptions of the side effects of cancer chemotherapy in the s repeatedly demonstrated that CINV was one of the most significant and distressing symptoms for patients with cancer receiving chemotherapy On the contrary, a similar report in showed a marked change and indicated that predominant concerns were fatigue and psychosocial quality of life rather than CINV However, several studies have shown that CINV, including anticipatory nausea, remain a significant problem for patients receiving moderately or highly emetogenic regimens, even after treatment using 5-HT3 receptor antagonists and corticosteroids, and that physicians and nurses may underestimate the risk of delayed CINV Because once ANV develops, it is sometimes challenging to control and often persists for up to a year 46 , this is still a critical problem for patients with cancer who need highly emetogenic chemotherapeutic regimens Behavioral treatments for ANV include systematic desensitization and pharmacotherapies such as benzodiazepines; typical antiemetic agents are not effective for ANV Thus, the appropriate assessment and management of ANV are essential, particularly for patients with cancer who are treated using chemotherapeutic agents.
The experience with cancer is generally assumed to cause considerable stress, not only to patients but also to caregivers who share the patient's distressing illness trajectory. Family members most frequently fulfill the role of primary care providers for patients with cancer. In Japan, treatments for medical diseases such as cancer are increasingly provided on an outpatient basis; thus, much of the burden of care has shifted from healthcare professionals to patients and their families.
It is established that the death of a close family member is one of the most stressful life events However, there are cross-cultural differences in the function of the family between Western and Asian countries For example, family opinions are accorded a larger role by Japanese patients than by American patients, and this may affect decision-making processes, such as disclosure of an incurable cancer diagnosis However, some previous Japanese studies show that adjustment disorders and major depression are most common in families of patients with cancer 53 , 54 , and these findings are consistent with Western study findings.
It is interesting that these disorders are the most common psychiatric disorders among patients with cancer. These findings suggest that both patients with cancer and their families, as a socially integrated human unit, experience similar psychological distress during the illness trajectory Thus, good cancer care must include care for family members, and the Cancer Control Act emphasizes the care needs of the whole family.
There is no doubt that support for family members will become more essential; therefore, the development of a comprehensive support system for caregivers of patients with cancer is an urgent issue in clinical oncology in Japan. Cancer should be treated as a family issue and a family problem. Several previous studies have discussed the concept of a good death. For example, Steinhauser et al.
The Japanese findings demonstrate that medical staff should recognize broader good death concepts beyond symptom control. In addition to symptom management e.
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There has been substantial and continuous interest in whether factors such as human behavior style, personality traits, psychosocial factors, and life events affect the incidence of cancer and survival time among patients with cancer. Some previous studies have shown that people with certain personality traits are more susceptible to develop cancer and that coping styles following cancer diagnosis can influence longevity and survival 59 , However, some of this research was characterized by weak study designs, and more rigorous studies have since been conducted to replicate the findings However, many of the previous findings have not been adequately replicated.
Therefore, even though there is a substantial body of research on the associations between psychosocial factors and cancer outcomes, the findings are inconsistent 62 , A meta-analysis suggested that stress-related psychosocial factors have an adverse effect on cancer incidence and survival, although the analysis found evidence of publication bias, and the results should be interpreted with caution Because there is still great interest among the general population in the association between cancer outcomes and psychosocial factors, psycho-oncology is expected to clarify the relationship between these factors.
As mentioned above, more than 1 million Japanese people are diagnosed with cancer every year, and the number of cancer survivors is on the rise. Considering the large number of cancer survivors and their family members, and the fact that many of them experience psychological distress, psycho-oncology plays an essential role in improving the quality of life of patients and their families.
However, several issues need addressing, such as the insufficient number of psycho-oncologists, lack of high quality evidence about prevention, early detection, and treatment of psychological distress experienced by patients with cancer and their families while a recent Japanese study suggests the efficacy of oncologists' communication skills training on prevention for psychological distress among patients It is not easy to overcome cancer, but further developments in psycho-oncology may help individuals to live a fulfilling life even after they have been diagnosed with cancer.
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Biosci Trends. Psychiatric disorders in cancer patients: descriptive analysis of psychiatric referrals at two Japanese cancer center hospitals. Jpn J Clin Oncol. Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol. View Article PubMed. Akechi T, Uchitomi Y. Textbook of Palliative Medicine and Supportive Care.
Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. Depression and degree of acceptance of adjuvant cytotoxic drugs. A review of distress and its management in couples facing end-of-life cancer. A conference with the Supportive Care Team is held on Wednesdays, and a multicenter joint clinical teleconference involving six cancer center hospitals and three university hospitals is held on Thursdays.
In , the Supportive Care Center was developed. This center provides multi-professional attention to the individual's overall physical, psychosocial, and social needs, and cooperates with the Psycho-Oncology Division. The Supportive Care Team SCT , established in October , primarily aims to improve care for cancer patients and families facing a life-threatening illness. The role of the SCT is to implement comprehensive cancer care by assessing unrelieved symptoms physical and psychiatric and unattended needs, as well as efficiently managing physical symptoms, providing psychological support, and coordinating services.
The SCT is an interdisciplinary team composed of palliative care physicians, psychiatrists, certified nurse specialists, certified nurses, clinical psychologists, pharmacy practitioners, registered dietitians and social workers. The SCT keeps regular contact with clinician-teams in charge, discusses patients' needs, and refers patients and families to the appropriate services.
Here the St. I suggest that you seek some short-term psychodynamic therapy at this point to help you deal with the impending personal loss associated with terminating a pregnancy. The type of therapy I would recommend is called interpersonal psychotherapy. My breast cancer recurred in the irradiated involved breast. I had a mastectomy, and my workup studies revealed that the disease had not spread past the breast. My doctors once again gave me an excellent prognosis for cure.
I was placed on hormone therapy, am feeling physically well now, and am back at work. My problem is that I cannot shake the fear of the disease coming back again. Each time I feel any slight ache or pain, the fear becomes overwhelming. Is there any type of help for me to deal with this never-ending fear and anxiety? Yes, there is. What you are experiencing is a natural response to the distrust that this disease engenders in all who have been affected by it.
Living with anxiety-and fear of recurrence even in this scenario, where the likelihood of another recurrence may be low-is unacceptable. There are many medications available to alleviate the intensity of the fear and the anxiety. Besides medication stabilization, I would recommend a course of psychotherapy. Cognitive behavioral therapy CBT may help you reconstruct your instinctive negative thoughts and responses to more-positive conclusions with more functionally adaptive responses.
Conclusion The management of psychological symptoms associated with the cancer journey is complex. Several treatments currently exist to deal with emotional distress, including-but not limited to-psychotherapy and drug therapy. Each case requires individualized attention and therapy designed to address the issues at hand. For patient safety the administration of psychiatric medications requires knowledge of risks, contraindications, side effects, and potentially harmful drug interactions with chemotherapy, hormonal therapy, and other prescription or over-the-counter medications. Without the right tools to adequately identify emotional distress that might require professional attention, and if lacking familiarity with and in-depth knowledge of the different available therapies to deal with psychological issues, even the most empathetic and communicative physicians may remain unprepared to effectively manage the emotionally afflicted cancer patient.
It is clear that untreated psychosocial and emotional conflicts impair quality of life and may have a negative impact on treatment compliance and overall survival outcome. Massie MJ. Prevalence of depression in patients with cancer. Journal of the National Cancer Institute.
Symptom prevalence, characteristics and distress in a cancer population.