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内田 恵ウチダ メグミ

所属部署医学研究科共同研究教育センター
職名助教
メールアドレス
ホームページURLhttp://www.ncupsychiatry.com/jp/index.html
生年月日
Last Updated :2020/06/03

研究者基本情報

学位

  • 名古屋市立大学大学院 医学研究科修了/博士(医学)

研究活動情報

研究分野

  • ライフサイエンス, 精神神経科学

研究キーワード

    サイコオンコロジー, 精神心理的苦痛, せん妄, 精神科, がん

論文

  • Smartphone problem-solving and behavioural activation therapy to reduce fear of recurrence among patients with breast cancer (SMartphone Intervention to LEssen fear of cancer recurrence: SMILE project): protocol for a randomised controlled trial., Akechi T, Yamaguchi T, Uchida M, Imai F, Momino K, Katsuki F, Sakurai N, Miyaji T, Horikoshi M, Furukawa TA, Iwata H, Uchitomi Y, BMJ open, 8, (11) ,   2018年11月, 査読有り
  • Goals of care and treatment in terminal delirium: A qualitative study of the views and experiences of healthcare professionals caring for patients with cancer., Uchida M, Morita T, Ito Y, Koga K, Akechi T, Palliative & supportive care, 1 - 6,   2018年11月, 査読有り
  • Opioid Dose and Survival of Patients with Incurable Nonsmall Cell Lung Cancer: A Prospective Cohort Study., Takaaki Hasegawa, Tetsuya Oguri, Tomohiro Osawa, Toshiyuki Sawa, Satoshi Osaga, Toru Okuyama, Megumi Uchida, Ken Maeno, Satoshi Fukuda, Hirotada Nishie, Akio Niimi, Tatsuo Akechi, Journal of palliative medicine, 21, (10) 1436 - 1441,   2018年10月, 査読有り, BACKGROUND: Preclinical studies show that opioids promote angiogenesis, tumor progression, and metastasis, resulting in shorter survival. OBJECTIVE: To explore whether opioids are associated with the overall survival (OS) of patients with incurable nonsmall cell lung cancer (NSCLC). DESIGN: Prospective cohort study of patients with NSCLC. SETTING: We investigated patients newly diagnosed with advanced or post-operative recurrent NSCLC between April 2013 and December 2015 at a single institute. MEASUREMENTS: We evaluated OS, opioid requirements, opioid doses, pain levels, and prognostic factors of advanced NSCLC. The effects of variables on survival were analyzed using univariable and multivariable models. Patients were stratified according to oral morphine equivalents (OMEs)/day (<60 or ≥60 mg) to assess the association between opioid dose and OS. RESULTS: We analyzed 150 patients, including 64 who received opioid treatment during follow-up. The median OS was 242 days in the opioid group and 627 days in the no-opioid group (log-rank p < 0.001). Multivariable models revealed that the opioid requirement was an independent predictor of shorter OS, after adjustment for prognostic variables, including sex, histology, stage, history of systemic chemotherapy, and performance status (hazard ratio 1.73, 95% confidence interval 1.137-2.631). There was no significant difference in OS between patients who received ≥60 mg OME/day for 250 days versus <60 OME/day for 242 days. CONCLUSIONS: The opioid dose does not shorten the survival of patients with advanced NSCLC. The opioid requirement is associated with shorter survival when opioids are administered any time during the clinical course, independent of the influence of other key factors.
  • Does cognitive decline decrease health utility value in older adult patients with cancer?, Tatsuo Akechi, Sayo Aiki, Koji Sugano, Megumi Uchida, Atsuro Yamada, Hirokazu Komatsu, Takashi Ishida, Shigeru Kusumoto, Shinsuke Iida, Toru Okuyama, PSYCHOGERIATRICS, 17, (3) 149 - 154,   2017年05月, 査読有り, Aim: Cognitive decline is common among older adults with cancer. The present study aimed to investigate the impact of cognitive decline on health utility value in older adults suffering from cancer. Methods: Consecutive patients aged 65 years or older with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Patients were asked to complete the EuroQoL-5 (EQ-5D) scale to measure health utility and the Mini-Mental State Examination to assess cognitive decline. The potential impact of cognitive decline was investigated with univariate analysis. A multivariate regression analysis was conducted to control for potential confounding factors. Results: Complete data were obtained from 87 patients, 29% of whom had cognitive decline. The mean perpendicular to SE EQ-5D score for patients with cognitive decline was significantly lower than that for those without cognitive decline (0.67 +/- 0.04 vs 0.79 +/- 0.03, t = 2.38, P = 0.02). However, multiple regression analysis showed that cognitive decline was not significantly associated with EQ-5D scores. Female sex and lower performance scores (worse physical condition) were significantly associated with EQ-5D scores. Conclusions: Cognitive decline may be involved in decreased health utility value in older adult patients with cancer. However, this effect does not seem to be independent, and the patient's physical condition may be a relevant confounding factor.
  • Screening for untreated depression in cancer patients: a Japanese experience, Hironobu Inoguchi, Ken Shimizu, Haruki Shimoda, Kazuhiro Yoshiuchi, Tatsuo Akechi, Megumi Uchida, Asao Ogawa, Daisuke Fujisawa, Shinichiro Inoue, Yosuke Uchitomi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 46, (11) 993 - 999,   2016年11月, 査読有り, This study indicated that screening for untreated depression in cancer patients was not useful in the specific clinical settings, and such screening should be implemented in appropriate contexts.Guidelines for supportive care in cancer patients have recommended routine psychological screening in clinical practice, and a Japanese national project has recommended screening for depression using the Distress and Impact Thermometer. However, a previous study advocating the validity of the Distress and Impact Thermometer may have overestimated its effectiveness, as the study included already-treated patients who were not screening targets. This study re-evaluated the performance and usefulness of the Distress and Impact Thermometer using an adequate sample size and appropriate study design. Patients were consecutively recruited at two highly specialized hospitals and three university hospitals in Japan. Inclusion criteria were (i) undergoing aggressive anti-cancer treatment, (ii) the Eastern Cooperative Oncology Group performance status score < 3 and (iii) age > 20 years. Patients who were receiving psychiatric treatment were excluded from the study. After completing the Distress and Impact Thermometer, patients were evaluated with the gold-standard Composite International Diagnostic Interview by researchers who were blinded to the patients' Distress and Impact Thermometer scores. Forty-four patients (9%) who were receiving psychiatric treatment were excluded. Of 468 subjects included in the final analysis, only 3 had current depression (0.6%). Using cutoff points recommended by the previous study, the positive and negative predictive values were 0.02 and 0.99, respectively. Our data indicated that screening for untreated depression in cancer patients was not useful in the specific clinical settings that were studied, and such screening should be implemented in appropriate contexts. Since there are no evidence-based recommendations regarding contexts in which psychological screening is essential, further research is needed.
  • Current Status of Distress Screening in Designated Cancer Hospitals: A Cross-Sectional Nationwide Survey in Japan, Toru Okuyama, Yoshiyuki Kizawa, Tatsuya Morita, Hiroya Kinoshita, Megumi Uchida, Asami Shimada, Akemi Shirado Naito, Tatsuo Akechi, JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 14, (9) 1098 - 1104,   2016年09月, 査読有り, Background: The purpose of this study was to investigate the current status of distress screening implementation in Japanese designated cancer hospitals. Subjects and Methods: This was a cross-sectional observational study. Palliative care team representatives in all designated cancer hospitals in Japan completed an ad hoc questionnaire. Demographic data in 2014 were obtained from the Ministry of Health, Labour and Welfare in Japan. Results: Of 422 institutions, 389 responded (92%) and data were obtained from 379 (90%). Approximately 90% of institutions had implemented a distress screening program at some level, and approximately 60% had just started screening. Among those institutions that screened, 77% provided individualized triage to specialized services within the institutions, whereas 60% did not routinely follow-up with patients who had positive screening results. The estimated median percentage of screened patients referred to palliative care teams was 0.4% in outpatient settings and 6.3% in inpatient settings. Although 68% of respondents perceived that screening was useful overall, they also reported difficulties when conducting screening with patients, reporting "no established effective treatment for problems screened" (66%), "patients complain it is difficult to express their distress using scales" (58%), and that it was "difficult to manage screened problems because of lack of time" (49%). Eight perceived barriers to implementing distress screening programs in hospitals were identified; a lack of human resources ranked highest. Conclusions: Implementation of distress screening in designated cancer hospitals in Japan has just begun. Policymakers should acknowledge that screening can be beneficial for patients when it is implemented with appropriate resources and established methods.
  • Effectiveness of a psycho-oncology training program for oncology nurses: a randomized controlled trial, Yosuke Kubota, Toru Okuyama, Megumi Uchida, Shino Umezawa, Tomohiro Nakaguchi, Koji Sugano, Yoshinori Ito, Fujika Katsuki, Yumi Nakano, Takeshi Nishiyama, Yoshiko Katayama, Tatsuo Akechi, PSYCHO-ONCOLOGY, 25, (6) 712 - 718,   2016年06月, 査読有り, ObjectiveOncology nurses are expected to play an important role in psychosocial care for cancer patients. The aim of this study was to examine whether a novel training program aimed at enhancing oncology nurses' ability to assess and manage common psychological problems in cancer patients would improve participants' self-reported confidence, knowledge, and attitudes regarding care of patients with common psychological problems (trial register: UMIN000008559). MethodsOncology nurses were assigned randomly to either the intervention group (N=50) or the waiting list control group (N=46). The intervention group received a 16-h program, the content of which focused on four psychological issues: normal reactions, clinically significant distress, suicidal thoughts, and delirium. Each session included a role-play exercise, group work, and didactic lecture regarding assessment and management of each problem. Primary outcomes were changes in self-reported confidence, knowledge, and attitudes toward the common psychological problems between pre-intervention and 3months post-intervention. Secondary outcomes were job-related stress and burnout. Intervention acceptability to participants was also assessed. ResultsIn the intervention group, confidence and knowledge but not attitudes were significantly improved relative to the control group. No significant intervention effects were found for job- related stress and burnout. A high percentage (98%) of participants considered the program useful in clinical practice. ConclusionsThis psycho-oncology training program improved oncology nurses' confidence and knowledge regarding care for patients with psychological problems. Copyright (c) 2015 John Wiley & Sons, Ltd.
  • Assessing medical decision making capacity among cancer patients: Preliminary clinical experience of using a competency assessment instrument, Tatsuo Akechi, Toru Okuyama, Megumi Uchida, Koji Sugano, Yosuke Kubota, Yoshinori Ito, Nobuhiro Sakamoto, Yoshiyuki Kizawa, PALLIATIVE & SUPPORTIVE CARE, 13, (6) 1529 - 1533,   2015年12月, 査読有り, Object: This study investigates the usefulness of the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory (SICIATRI) for cancer patients, which is a structured interview that assesses a patient's competency in clinical practice. Methods: The SICIATRI, originally developed to measure patients' competency to give informed consent, were administered referred cancer patients who needed for assessing medical decision making capacity. The usefulness of the SICIATRI was investigated retrospectively. Recommendation for modification of the SICIATRI for cancer patients if applicable were made by the research team. Results: Among the 433 cancer patients referred for psychiatric consultation, 12 were administered the SICIATRI and all of the administration were conducted without big problems. All patients were 60 years or older. The most common purpose for competency evaluation was to analyze patients' understanding of the anti-cancer treatment proposed by oncologists, followed by their refusal of the treatment. Half of the patients (n = 6) were diagnosed with delirium and three among them were judged as having the most impaired status of a patient's competency. Two patients (17%) were diagnosed with major depression and another two (17%) were mental retardation and each one patient was diagnosed with dementia and past history of alcohol dependence. Among 6 patients without delirium 5 subjects including a dementia patient were judged as fully competent. Total of 5 small potential modifications of the SICIATRI for its use with Japanese cancer patients were recommended. Significance of results: Our experience suggests that the SICIATRI is a useful instrument for psycho-oncology clinical practice.
  • The Association Between Depressive Symptoms and Age in Cancer Patients: A Multicenter Cross-Sectional Study, Saho Wada, Ken Shimizu, Hironobu Inoguchi, Haruki Shimoda, Kazuhiro Yoshiuchi, Tatsuo Akechi, Megumi Uchida, Asao Ogawa, Daisuke Fujisawa, Shinichirou Inoue, Yosuke Uchitomi, Eisuke Matsushima, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 50, (6) 768 - 777,   2015年12月, 査読有り, Context. There is controversy around the association between depressive symptoms and age in adult cancer patients. Objectives. The aim of this study was to evaluate the following hypotheses: 1) cancer patients' depressive symptoms decrease with age, and 2) in individuals aged 65 years or older, depressive symptoms increase because of the effect of somatic symptoms. Methods. We retrospectively analyzed a database of 356 cancer patients who were consecutively recruited in a previous multicenter cross-sectional study. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9), and correlations with age and other factors were assessed by hierarchical multivariate regression analysis. Age was entered as the dependent variable in the first step, patient characteristics and cancer-related variables were entered in the second step, and somatic symptoms were entered in the last step. We analyzed this model for both the total sample and the subpopulation aged 65 years or older. Results. In the total sample, the PHQ-9score was significantly associated with lower age, fatigue, and shortness of breath(adjusted R-2 14.2%). In the subpopulation aged 65 years or older, no factor was associated with the PHQ-9 score (adjusted R-2 7.3%). Conclusion. The finding that depressive symptoms in cancer patients decreased with age was concordant with our first hypothesis, but the second hypothesis was not supported. Younger cancer patients were vulnerable to depressive symptoms and should be monitored carefully. Further studies using more representative samples are needed to examine in detail the association between depressive symptoms and age in older cancer patients. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
  • Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study, Megumi Uchida, Toru Okuyama, Yoshinori Ito, Tomohiro Nakaguchi, Mikinori Miyazaki, Masaki Sakamoto, Takeshi Kamiya, Shigeki Sato, Hiromitsu Takeyama, Takashi Joh, David Meagher, Tatsuo Akechi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 45, (10) 934 - 940,   2015年10月, 査読有り, The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer. Patients aged a parts per thousand yen65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission. Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16). Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.
  • Difference of patient's perceived need in breast cancer patients after diagnosis., Akechi T, Uchida M, Nakaguchi T, Okuyama T, Sakamoto N, Toyama T, Yamashita H, Japanese journal of clinical oncology, 45, (1) 75 - 80,   2015年01月, 査読有り
  • Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians., Sugano K, Okuyama T, Iida S, Komatsu H, Ishida T, Kusumoto S, Uchida M, Nakaguchi T, Kubota Y, Ito Y, Takahashi K, Akechi T, PloS one, 10, (8) ,   2015年, 査読有り
  • Oncology Nurses' Recognition of Supportive Care Needs and Symptoms of their Patients Undergoing Chemotherapy, Tomohiro Nakaguchi, Toru Okuyama, Megumi Uchida, Yoshinori Ito, Hirokazu Komatsu, Makoto Wada, Tatsuo Akechi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 43, (4) 369 - 376,   2013年04月, 査読有り, To assess the accuracy of oncology nurses recognition of supportive care needs and symptoms of their patients undergoing chemotherapy. The participants comprised randomly selected cancer outpatients receiving chemotherapy in an ambulatory setting and 17 oncology nurses working in two chemotherapy units in Japan. For assessment of the patients supportive care needs and symptoms, the patients were asked to respond to a validated self-administered questionnaire. The oncology nurses completed a survey in which they indicated their perception of the level of the same set of needs or symptoms. The two data sets obtained from the patients and nurses were compared statistically to assess the accuracy of the oncology nurses recognition of their patients needs and symptoms. Complete data sets were available for 439 patients. The most common primary cancers were breast cancer (36.0), followed by colorectal (24.4) and lung (12.3) cancers. Nurses awareness of their patients supportive care needs and physical and psychological symptoms were less than optimal in routine care. In particular, psychological symptoms and support needs for these symptoms were markedly under-recognized. Physical symptoms associated with chemotherapy, such as hair loss, appetite loss and fatigue, were better recognized than symptoms not specific to chemotherapy, such as constipation, insomnia, dyspnea and pain. Oncology nurses recognition may not accurately reflect their patients supportive care needs and symptoms in routine practice. In clinical practice, it may be beneficial to conduct routine screening of patients perceived needs and symptoms comprehensively using self-administered questionnaires.
  • Clinical Indicators of Depression among Ambulatory Cancer Patients Undergoing Chemotherapy, Tatsuo Akechi, Toru Okuyama, Megumi Uchida, Tomohiro Nakaguchi, Koji Sugano, Yosuke Kubota, Yoshinori Ito, Yoshiyuki Kizawa, Hirokazu Komatsu, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 42, (12) 1175 - 1180,   2012年12月, 査読有り, This study aimed to investigate clinical indicators of depression among randomly selected ambulatory patients with cancer who were receiving chemotherapy. The patients were asked to complete the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer QLQ-C 30 and an ad hoc questionnaire regarding several additional common chemotherapy-related symptoms. Complete data were available for 211 patients. Of the total, 13.7 patients experienced clinical depression. The presence of clinical depression was significantly associated with patient demographic characteristics (education level) as well as several symptoms such as the presence of pain, sleep disturbances, loss of appetite, nausea and fatigue. Multivariate logistic regression analysis indicated that a lower education level and the presence of pain were significantly associated with clinical depression. These findings suggest that ambulatory cancer patients who are receiving chemotherapy and have pain and/or a lower education level have a higher probability of suffering from clinical depression; these factors may be useful for the early identification of depression in cancer patients.
  • Perceived Needs, Psychological Distress and Quality of Life of Elderly Cancer Patients, Tatsuo Akechi, Toru Okuyama, Megumi Uchida, Tomohiro Nakaguchi, Yoshinori Ito, Hiroko Yamashita, Tatsuya Toyama, Hirokazu Komatsu, Yoshiyuki Kizawa, Makoto Wada, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 42, (8) 704 - 710,   2012年08月, 査読有り, Very few findings regarding the perceived needs of elderly cancer patients have been reported. This study investigated needs and psychological distress perceived by and/or quality of life of elderly cancer patients. Randomly selected ambulatory patients with cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexual); the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer QLQ-C 30. Complete data were available for 619 cancer patients, including 113 subjects who were over 70 years old. The needs and the psychological distress perceived by the elderly patients were comparable with those perceived by relatively younger patients, although elderly patients perceived fewer sexual needs. Regarding the quality of life global health status, most symptom-related quality of life parameters were not significantly different between the two groups, while significant differences were observed with regard to several functional domains, including physical, emotional and social domains in addition to financial difficulties. Only a few differences in the needs and the psychological distress perceived by patients existed between the elderly and the younger subjects, although some differences in the quality of life domains were noted, probably as a result of the influence of aging itself. Medical staff should provide elderly cancer patients with good clinical care similar to that provided to younger patients while considering the different impacts of aging on each quality of life dimension.
  • Oncologists' Recognition of Supportive Care Needs and Symptoms of Their Patients in a Breast Cancer Outpatient Consultation, Toru Okuyama, Tatsuo Akechi, Hiroko Yamashita, Tatsuya Toyama, Tomohiro Nakaguchi, Megumi Uchida, Toshiaki A. Furukawa, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 41, (11) 1251 - 1258,   2011年11月, 査読有り, Objective: The purpose of this study was to investigate the accuracy of oncologists' recognition of their patients' supportive care needs and symptoms in breast cancer outpatient consultation in Japan. Methods: The participants included a sample of randomly selected outpatients with breast cancer and two oncologists. The patients responded to validated self-administered questionnaires to assess their supportive care needs and symptoms. The oncologists responded to a questionnaire in which they indicated their perception of level of the same set of needs or symptoms following consultation. The two data sets were compared statistically. Results: Complete data sets were available for 408 patients. Low negative predictive values for the psychological (30%) and information domain (30%) indicated that the patients often have psychological and information needs that the oncologists do not appropriately recognize. The sensitivity and specificity of the physicians' assessment for all physical symptoms except pain were <40 and >85%, respectively, indicating that the physicians could not detect, but could rule out the possibility of a patient experiencing physical symptoms. Borderline/clinical depression and anxiety were the only two symptoms that the oncologists reported more frequently than the patients did. As a result, the specificity of the physicians' assessment for the detection of borderline/clinical depression and anxiety was relatively low (74 and 27%). Conclusions: Oncologists' recognition may not accurately reflect their patients' supportive care needs and symptoms in usual care. Incorporation of a standard assessment system for supportive care needs and symptoms in clinical practice must heighten the oncologists' awareness of their patients' these problems.
  • Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan, Tatsuo Akechi, Toru Okuyama, Chiharu Endo, Ryuichi Sagawa, Megumi Uchida, Tomohiro Nakaguchi, Terukazu Akazawa, Hiroko Yamashita, Tatsuya Toyama, Toshiaki A. Furukawa, PSYCHO-ONCOLOGY, 20, (5) 497 - 505,   2011年05月, 査読有り, Objective: A needs assessment can be used as a direct index of what patients perceive they need help with. The purposes of this study were to investigate the association between patients' perceived needs and psychological distress and/or quality of life (QOL) and to clarify the characteristics of patients with a high degree of unmet needs. Methods: Randomly selected ambulatory female patients with breast cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs); the Hospital Anxiety and Depression Scale; and the European Organization for Research and Treatment of Cancer QLQ-C 30. Results: Complete data were available for 408 patients. The patients' needs were significantly associated with both psychological distress (r = 0.63, p < 0.001) and QOL (r = -0.52, p < 0.001). A multiple regression analysis revealed that employment status (without full-time /part-time job), duration since diagnosis (less than 6 months), advanced stage, and a lower performance status were significantly associated with higher total needs. Only sexuality needs were significantly associated with a younger age, while the other domains were significantly associated with duration since diagnosis, advanced stage, and a lower performance status. Conclusions: Moderate to strong associations exist between patients' needs and psychological distress and/or QOL. The characteristics associated with patients' needs are multi-factorial, and interventions to respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL. Copyright (C) 2010 John Wiley & Sons, Ltd.
  • Patients' Supportive Care Needs and Psychological Distress in Advanced Breast Cancer Patients in Japan, Megumi Uchida, Tatsuo Akechi, Toru Okuyama, Ryuichi Sagawa, Tomohiro Nakaguchi, Chiharu Endo, Hiroko Yamashita, Tatsuya Toyama, Toshiaki A. Furukawa, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 41, (4) 530 - 536,   2011年04月, 査読有り, Objective: Few studies have investigated the prevalence of the unmet needs among advanced or recurrent breast cancer patients in Asian countries and little is known about the relation between their unmet needs and psychological distress/quality of life. Methods: The participants (n = 87) comprised randomly selected ambulatory female patients with advanced or recurrent breast cancer attending the Outpatient Department of Oncology, Immunology and Surgery of Nagoya City University Hospital. The patients were asked to complete self-administered questionnaires assessing the level of their physical and psychological symptoms, supportive care needs and socio-demographic and biomedical factors. The association between the patients' perceived needs and psychological distress/quality of life was then analyzed statistically. Results: The patients had a mean +/- standard deviation of 11 +/- 7.7 and a median of 10 unmet needs. The prevalence of the 17 most frequent unmet needs was over 50%, and almost all of these unmet need items belonged to the Psychological or the Health system and information domain. The total Short-form Supportive Care Needs Survey Questionnaire with cancer score was significantly associated with the indices of psychological distress and quality of life. Most of the Short-form Supportive Care Needs Survey Questionnaire with cancer domains except Sexuality domain were also significantly associated with all the indices of psychological distress. Conclusions: Psychosocial needs were strongly associated with psychological distress and quality of life. Quality of life and psychological distress may be improved if interventions for unmet needs, especially psychological and information needs, are made.
  • Social anxiety disorder as a hidden psychiatric comorbidity among cancer patients, Tatsuo Akechi, Toru Okuyama, Ryuichi Sagawa, Megumi Uchida, Tomohiro Nakaguchi, Yoshinori Ito, Toshiaki A. Furukawa, PALLIATIVE & SUPPORTIVE CARE, 9, (1) 103 - 105,   2011年03月, 査読有り, Objective: Social anxiety disorder is one of the most popular psychiatric disorders in the general population and is also well known as a very common comorbid psychiatric disorder among patients with major depression. On the other hand, social anxiety disorder has been termed "the neglected anxiety disorder" because its diagnosis is often missed. Furthermore, the potential impact of social anxiety disorder on the psychological distress of cancer patients has not been reported. Method: We encountered two cancer patients with refractory depression after cancer diagnosis, in whom comorbid social anxiety disorder was unexpectedly detected during a subsequent follow-up. Results: To the best of our knowledge, this is the first report to discuss the potential impact of social anxiety disorder on cancer patients' distress. These two cases may help to improve our understanding of the complicated mental health problems of cancer patients and the potential influence of social anxiety disorder on patients' follow-up medical treatment. Significance of results: Comorbid social anxiety disorder should be considered when a cancer patient's depression is resistant to treatment and the existence of communication problems between the patient and the medical staff is suspected.
  • Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: Prevalence, associated factors, and impact on quality of life, Tatsuo Akechi, Toru Okuyama, Chiharu Endo, Ryuichi Sagawa, Megumi Uchida, Tomohiro Nakaguchi, Masaki Sakamoto, Hirokazu Komatsu, Ryuzo Ueda, Makoto Wada, Toshiaki A. Furukawa, CANCER SCIENCE, 101, (12) 2596 - 2600,   2010年12月, 査読有り, The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short-form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients' outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients' needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596-2660).
  • Delirium Training Program for Nurses, Tatsuo Akechi, Chieko Ishiguro, Toru Okuyama, Chiharu Endo, Ryuichi Sagawa, Megumi Uchida, Toshiaki A. Furukawa, PSYCHOSOMATICS, 51, (2) 106 - 111,   2010年03月, 査読有り, Background: Delirium is a common and serious clinical problem for hospitalized patients and is associated with an increased risk of morbidity and mortality and increased healthcare costs. Objective: The objective of this study was to investigate the preliminary usefulness of a novel delirium training program to improve nurses' self-confidence in caring for patients with delirium. Method: One or more nurses were selected from each ward to become the "delirium-link nurses," and these nurses would then pass on their special training to the other nurses in their ward. Results: The outcome was evaluated with a self-reported 15-item measure to assess self-confidence. A total of 390 nurses, including 32 delirium-link nurses, participated in this program. A significant effect was observed for 12 of the 15 items. Conclusion: This brief program can improve nurses' self-confidence in treating delirium patients; however, more work is needed to improve nurses' ability to detect delirium early. (Psychosomatics 2010; 51:106-111)
  • Reliability and validity of the Japanese version of the Short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-J), Toru Okuyama, Tatsuo Akechi, Hiroko Yamashita, Tatsuya Toyama, Chiharu Endo, Ryuichi Sagawa, Megumi Uchida, Toshiaki A. Furukawa, PSYCHO-ONCOLOGY, 18, (9) 1003 - 1010,   2009年09月, 査読有り, Purpose: Provision of supportive care to meet patients' individual needs is instrumental to enhancing their quality of life. We therefore need an appropriate assessment tool to measure such needs. The purpose of this study was to examine the psychometric property of the Japanese version of the Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34-J). Subjects and methods: The forward-backward translation method was used to develop the Japanese version of SCNS-SF34, originally developed by Boyes et al. in Australia. Randomly selected ambulatory female patients with breast cancer participated in this study. They were asked to complete the SCNS-SF34-J and the European Organization for Research and Treatment of Cancer QLQ-C 30. The validity and the reliability of SCNS-SF34-J were evaluated statistically. Results: Complete data were available from 408 patients. A five-factor solution that accounted for 74.6% of the total variance was reproduced. The results confirmed the five-factor structure found in the original SCNS development study, consisting of Health system and Information needs, Psychological needs, Physical needs, Care and Support needs, and Sexuality needs. Cronbach's alpha coefficients, which are the measures of the internal consistency, were above 0.85 for all of five subscales. Significant correlations were also found for corresponding subscales in each of the instruments. The anticipated differences in supportive care needs between groups divided by the patient characteristics, such as the disease stage, were found to be significant. Conclusion: The results indicated that SCNS-SF34-J is a valid and reliable tool for assessing the supportive care needs of Japanese cancer patients. Copyright (C) 2009 John Wiley & Sons, Ltd.
  • Etiologies of Delirium and Their Relationship to Reversibility and Motor Subtype in Cancer Patients, Ryuichi Sagawa, Tatsuo Akechi, Toru Okuyama, Megumi Uchida, Toshiaki A. Furukawa, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 39, (3) 175 - 182,   2009年03月, 査読有り, Background: Delirium is one of the most commonly encountered complications in patients with cancer. The etiology of delirium in cancer is often multi-factorial, and few reports have examined the causes of delirium. This study investigated the causes of delirium and their association with reversibility and motor subtypes of delirium in cancer patients. Methods: The subjects were inpatients with cancer who had been referred to our Department of Psychiatry and diagnosed with delirium by psychiatrists. The causes of delirium were determined using standard operationalized criteria. The association between delirium reversibility and each clinical factor was examined in detail and longitudinally. Results: Data were available from a total of 100 patients. Among them, 58% had hyperactive delirium and 14% had hypoactive delirium. Delirium improved in 56% of the patients after 1 week of standard treatment. The most frequent causes of delirium were opioids (29%), inflammation (27%), dehydration and/or sodium level abnormalities (15%). While two or more causes were identified in 40% or more of the cases, the cause of delirium was not identified in 20% of the patients. Neither reversibility nor motor subtypes of delirium was associated with any specific etiological factor. Conclusions: When treating delirium, prevalences of the causes of delirium, as identified in this study, should be kept in mind. Further research is required to investigate what specific treatments may facilitate the prompt recovery from delirium among cancer patients.
  • Postictal cardiovascular response predicts therapeutic efficacy of electroconvulsive therapy for depression, Hideki Azuma, Akiko Fujita, Kiyoe Sato, Keiko Arahata, Kazuyuki Otsuki, Miki Hori, Yoshihito Mochida, Megumi Uchida, Tomoko Yamada, Tatsuo Akechi, Toshi A. Furukawa, PSYCHIATRY AND CLINICAL NEUROSCIENCES, 61, (3) 290 - 294,   2007年06月, 査読有り, Physiological parameters such as blood pressure (BP) and heart rate (HR) reflect autonomic response after seizure and may correlate with therapeutic efficacy in electroconvulsive therapy (ECT). However, the literature has been inconclusive with regard to the relationship between the effectiveness of ECT and physiological markers without atropine. In a consecutive sample of 24 patients with a drug-resistant major depressive episode who underwent modified sine or pulse wave ECT without atropine, the correlation was examined between BP and HR before, and 2 min after electrical stimulation and therapeutic efficacy on depressive symptoms. When mode of stimulation (sine wave or pulse wave) and baseline Hamilton Rating Scale for Depression (HRSD) were controlled for, postictal diastolic BP, systolic BP, HR and rate pressure product (RPP) were all found to be significant predictors of post-treatment HRSD. When these predictors were entered into stepwise regression, both postictal systolic BP and HR remained as significant predictors. The higher these postical physiological parameters, the more effective the course of ECT. It may be useful to examine such sensitive physiological parameters as BP, HR or RPP to determine effective or non-effective electrical seizure.
  • Postictal suppression correlates with therapeutic efficacy for depression in bilateral sine and pulse wave electroconvulsive therapy, Hideki Azuma, Akiko Fujita, Kiyoe Sato, Keiko Arahata, Kazuyuki Otsuki, Miki Hori, Yoshihito Mochida, Megumi Uchida, Tomoko Yamada, Tatsuo Akechi, Toshi A. Furukawa, PSYCHIATRY AND CLINICAL NEUROSCIENCES, 61, (2) 168 - 173,   2007年04月, 査読有り, Ictal electroencephalography (EEG) parameters in electroconvulsive therapy (ECT) for depression reportedly correlate with therapeutic response and stimulus dosage, particularly in right unilateral (RUL) ECT. The authors examined ictal EEG parameters as predictors of therapeutic effectiveness in bilateral (BL) sine and pulse wave ECT. A total of 30 consecutive depressed inpatients who had not responded to standard pharmacotherapy were treated using BL ECT given in either sine or pulse wave mode. Ictal EEG parameters (e.g. regularity, postictal suppression) were manually rated by three trained psychiatrists. Polyspike phase duration was significantly longer in sine wave ECT than in pulse wave ECT. Postictal suppression emerged as the only significant predictor of therapeutic outcome when baseline Hamilton Rating Scale for Depression and mode of stimulation were controlled for. Postictal suppression appears to offer a useful predictor of clinical outcome of depression in BL ECT. No EEG parameters were found to be differentially predictive between sine and pulse wave ECT.
  • Memory, attention, and executive functions before and after sine and pulse wave electroconvulsive therapies for treatment-resistant major depression, A Fujita, S Nakaaki, K Segawa, H Azuma, K Sato, K Arahata, K Otsuki, M Hori, Y Mochida, M Uchida, T Yamada, C Nakamura, T Akechi, TA Furukawa, JOURNAL OF ECT, 22, (2) 107 - 112,   2006年06月, 査読有り, Studies of the cognitive effects of electroconvulsive therapy (ECT) have resulted in controversial findings up to now, partly because researchers and reviewers have not always made a clear distinction among various aspects of cognition and because there are many parameters involved in the administration of ECT that have a potential impact on cognition. The present study focused on the impact of sine and pulse waveforms on anterograde memory and nonmemory cognitive functions. Methods: We assigned 18 patients with unipolar major depression or bipolar I or II disorder, most recent episode depressed, to receive sine wave or pulse wave ECT and assessed their cognitive function before and after ECT, using a neuropsychologic test battery that measured anterograde memory, attention, and executive functions. Outcomes were measured, on average, 8.2 days after the last ECT session. Results: Both waveforms were equally effective in alleviating depression. Those who received sine wave ECT showed statistically significant deterioration in attention and executive tasks, such as the Stroop test, which measures selective attention (P = 0.02), and the dual task, which taps divided attention (P = 0.01). On the other hand, those who received pulse wave ECT improved to a significant degree in certain memory tasks, such as visual memory (P = 0.01) and general memory (P = 0.01) of the Wechsler Memory Scale-Revised (WMS-R), as well as in the dual task (P = 0.01). The between-group comparison revealed robust superiority of the pulse wave over the sine wave in terms of the dual task (P = 0.004). Conclusions: Anterograde memory improved to a statistically significant or nonsignificant degree at 1 week post-ECT in comparison with pre-ECT regardless of waveforms. Attention/executive functions tended to deteriorate with sine wave ECT but improved with pulse wave ECT.


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