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奥山 徹オクヤマ トオル

所属部署医学研究科共同研究教育センター
職名病院准教授
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 :2020/05/28

研究者基本情報

基本情報

    科研費研究者番号:80349349
    ORCID ID:0000-0003-0504-6406

学位

  • 東海大学/博士(医学)

研究活動情報

研究キーワード

    抗精神病薬, せん妄, 精神科, がん

論文

  • Depressive symptoms during the first month of chemotherapy and survival in patients with hematological malignancies: A prospective cohort study., Takaaki Hasegawa, Toru Okuyama, Megumi Uchida, Sayo Aiki, Fuminobu Imai, Masahiro Nishioka, Nana Suzuki, Shinsuke Iida, Hirokazu Komatsu, Shigeru Kusumoto, Masaki Ri, Satoshi Osaga, Tatsuo Akechi, Psycho-oncology, 28, (8) 1687 - 1694,   2019年08月, 査読有り, OBJECTIVE: The objective of the study is to investigate depressive symptoms before and after the initiation of chemotherapy and their impact on overall survival (OS) among patients with hematological malignancies. METHODS: We performed a prospective analysis of consecutive patients with newly diagnosed malignant lymphoma or multiple myeloma enrolled between September 2010 and March 2016. We evaluated depression symptoms at two time points: before starting chemotherapy (T1) and 1 month later (T2), using PHQ-9 and known prognostic factors. We allocated participants with depressive symptoms at T1 and/or T2 to a depression group that was subdivided as follows: new depressive symptoms at T2, ("new-onset"), remission of depressive symptoms at T2 ("remission"), and persistent depressive symptoms from T1 to T2 ("persistent"). The main outcome, OS, was evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards modeling. RESULTS: Of the 294 eligible participants, we analyzed 255 patients, including 83 with depression. There were 19 participants in the new-onset, 38 in the remission, and 26 in the persistent depression group. The OS of participants with depression was significantly shorter than that of those without depression (adjusted hazard ratio [AjHR] 2.43; 95% confidence interval [CI] 1.43-4.12; P < .001). Using the never-depressive symptoms group as a reference group, AjHRs were as follows: new-onset, 1.91 (95% CI, 0.77-4.75; 0.166); remission, 2.98 (95% CI, 1.55-5.74; 0.001), and persistent, 2.17 (95%CI, 1.01-4.68; 0.047). CONCLUSIONS: Among patients with mature lymphoid malignancy, the group with depression at baseline had a poorer survival, both in the group that remained depressive and the group that recovered from depressive symptoms.
  • Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R)., Okuyama T, Yoshiuchi K, Ogawa A, Iwase S, Yokomichi N, Sakashita A, Tagami K, Uemura K, Nakahara R, Akechi T, Phase‐R Delirium, Study Group, The oncologist, 24, (7) e574 - e582,   2019年07月, 査読有り
  • [Current Status and Challenges of Advance Care Planning in Cancer Patients]., Takaaki Hasegawa, Toru Okuyama, Tatsuo Akechi, Gan to kagaku ryoho. Cancer & chemotherapy, 46, (4) 609 - 616,   2019年04月, 査読有り, Awareness of the importance of advance care planning(ACP)to archive individual patients' end-of-life wishes has been spreading. The aim of this review is to summarize recent studies on the effects of ACP, and also provides a narrative summary of the practical challenges raised by ACP. We consider that it is important to assess patients' readiness to participate in ACPby discussing prognostic understanding, patients' personal value and denial mechanisms to cope.
  • What is the appropriate communication style for family members confronting difficult surrogate decision-making in palliative care?: A randomized video vignette study in medical staff with working experiences of clinical oncology., Nishioka M, Okuyama T, Uchida M, Aiki S, Ito Y, Osaga S, Imai F, Akechi T, Japanese journal of clinical oncology, 49, (1) 48 - 56,   2019年01月, 査読有り
  • WITHDRAWN: Psychotherapy for depression among incurable cancer patients., Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA, The Cochrane database of systematic reviews, 11,   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.
  • Effectiveness of a brief psycho-oncology training program for general nurses: a preliminary study., Kubota Y, Akechi T, Okuyama T, Japanese journal of clinical oncology, 48, (6) 594 - 597,   2018年06月, 査読有り
  • Cognitive dysfunction among newly diagnosed older patients with hematological malignancy: frequency, clinical indicators and predictors., Aiki S, Okuyama T, Sugano K, Kubota Y, Imai F, Nishioka M, Ito Y, Iida S, Komatsu H, Ishida T, Kusumoto S, Akechi T, Japanese journal of clinical oncology, 48, (1) 61 - 67,   2018年01月, 査読有り
  • Supportive care needs and psychological distress and/or quality of life in ambulatory advanced colorectal cancer patients receiving chemotherapy: a cross-sectional study, Nobuhiro Sakamoto, Shuji Takiguchi, Hirokazu Komatsu, Toru Okuyama, Tomohiro Nakaguchi, Yosuke Kubota, Yoshinori Ito, Koji Sugano, Makoto Wada, Tatsuo Akechi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 47, (12) 1157 - 1161,   2017年12月, 査読有り, Advanced colorectal cancer patients receiving chemotherapy had various supportive care needs, and those needs were associated with both psychological distress and quality of life.Although currently many advanced colorectal cancer patients continuously receive chemotherapy, there are very few findings with regard to the supportive care needs of such patients. The purposes of this study were to investigate the patients' perceived needs and the association with psychological distress and/or quality of life, and to clarify the characteristics of patients with a high degree of unmet needs. Ambulatory colorectal cancer patients who were receiving chemotherapy 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 Quality of Life Questionnaire. Complete data were available for 100 patients. Almost all of the top 10 most common unmet needs belonged to the psychological domain. The patients' total needs were significantly associated with both psychological distress (r = 0.65, P < 0.001) and quality of life (r = -0.38, P < 0.001). A multiple regression analysis revealed that the female gender was significantly associated with higher total needs. The moderate to strong associations that exist between patients' needs and psychological distress and/or quality of life suggest that interventions that respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing quality of life. Female patients' needs should be evaluated more carefully.
  • Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis, Toru Okuyama, Tatsuo Akechi, Lisa Mackenzie, Toshi A. Furukawa, CANCER TREATMENT REVIEWS, 56, 16 - 27,   2017年05月, 査読有り, Background: There is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs). Methods: We searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: Of 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD -0.67, 95% confidence interval -1.06 to -0.29, P = 0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high. Conclusions: Low quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression. (C) 2017 Elsevier Ltd. All rights reserved.
  • 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.
  • 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.
  • Impact of depression on health utility value in cancer patients, Daisuke Fujisawa, Hironobu Inoguchi, Haruki Shimoda, Kazuhiro Yoshiuchi, Shinichiro Inoue, Asao Ogawa, Toru Okuyama, Tatsuo Akechi, Masaru Mimura, Ken Shimizu, Yosuke Uchitomi, PSYCHO-ONCOLOGY, 25, (5) 491 - 495,   2016年05月, 査読有り, ObjectiveThe quality-adjusted life year, which is usually calculated from the health utility value, is now a standard measurement used in political decision-making in health. Although depression is the leading cause of decrement in health utility in general population, impact of comorbid depression among cancer patients has not been studied sufficiently. Therefore, this study aimed to measure the impact of depression on cancer patients' health utility score, according to the severity of depression. MethodsImpact of depression severity (measured by the Patient Health Questionnaire) on health utility score (measured by the EuroQoL-5 scale) was evaluated in a sample of 328 Japanese cancer patients, controlling for performance status, symptom burden, and demographic variables. ResultsThe patients with depression had significantly lower health utility value than those without depression (mean decrement=0.14). Decrements in health utility of 0.13, 0.18, and 0.19 were observed for mild, moderate, and moderately severe to severe level of depression, respectively. The difference was significant between groups. Depression severity was a significant predictor for health utility (standardized coefficient beta=-0.25), which was comparable with physical symptom burden and performance status. Participants' age, gender, cancer stage, and comorbid illness were not significant. The model explained 37.9% of the variance. ConclusionsEven mild level of depression caused clinically meaningful decrement in health utility value in cancer patients, which was comparable with decrements due to major physical complications of cancer. Influence of depression should be carefully investigated when interpreting the quality-adjusted life year among cancer patients. Copyright (c) 2015 John Wiley & Sons, Ltd.
  • Screening Performance for Frailty Among Older Patients With Cancer: A Cross-Sectional Observational Study of Two Approaches., Okuyama T, Sugano K, Iida S, Ishida T, Kusumoto S, Akechi T, Journal of the National Comprehensive Cancer Network : JNCCN, 13, (12) 1525 - 1531,   2015年12月, 査読有り
  • Assessing medical decision making capacity among cancer patients: Preliminary clinical experience of using a competency assessment instrument., Akechi T, Okuyama T, Uchida M, Sugano K, Kubota Y, Ito Y, Sakamoto N, Kizawa Y, Palliative & supportive care, 13, (6) 1529 - 1533,   2015年12月, 査読有り
  • Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study., Uchida M, Okuyama T, Ito Y, Nakaguchi T, Miyazaki M, Sakamoto M, Kamiya T, Sato S, Takeyama H, Joh T, Meagher D, Akechi T, Japanese journal of clinical oncology, 45, (10) 934 - 940,   2015年10月, 査読有り
  • Good death for children with cancer: a qualitative study., Ito Y, Okuyama T, Ito Y, Kamei M, Nakaguchi T, Sugano K, Kubota Y, Sakamoto N, Saitoh S, Akechi T, Japanese journal of clinical oncology, 45, (4) 349 - 355,   2015年04月, 査読有り
  • 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
  • Cancer patients' function, symptoms and supportive care needs: a latent class analysis across cultures., Reese JB, Blackford A, Sussman J, Okuyama T, Akechi T, Bainbridge D, Howell D, Snyder CF, Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 24, (1) 135 - 146,   2015年01月, 査読有り
  • Using the EORTC-QLQ-C30 in clinical practice for patient management: identifying scores requiring a clinician's attention, Claire F. Snyder, Amanda L. Blackford, Toru Okuyama, Tatsuo Akechi, Hiroko Yamashita, Tatsuya Toyama, Michael A. Carducci, Albert W. Wu, QUALITY OF LIFE RESEARCH, 22, (10) 2685 - 2691,   2013年12月, 査読有り, Purpose Patient-reported outcomes (PROs) are used increasingly for individual patient management. Identifying which PRO scores require a clinician's attention is an ongoing challenge. Previous research used a needs assessment to identify EORTC-QLQ-C30 cutoff scores representing unmet needs. This analysis attempted to replicate the previous findings in a new and larger sample. Methods This analysis used data from 408 Japanese ambulatory breast cancer patients who completed the QLQ-C30 and Supportive Care Needs Survey-Short Form-34 (SCNS-SF34). Applying the methods used previously, SCNS-SF34 item/domain scores were dichotomized as no versus some unmet need. We calculated area under the receiver operating characteristic curve (AUC) to evaluate QLQ-C30 scores' ability to discriminate between patients with no versus some unmet need based on SCNS-SF34 items/domains. For QLQ-C30 domains with AUC >= 0.70, we calculated the sensitivity, specificity, and predictive value of various cutoffs for identifying unmet needs. We hypothesized that compared to our original analysis, (1) the same six QLQ-C30 domains would have AUC >= 0.70, (2) the same SCNS-SF34 items would be best discriminated by QLQ-C30 scores, and (3) the sensitivity and specificity of our original cutoff scores would be supported. Results The findings from our original analysis were supported. The same six domains with AUC >= 0.70 in the original analysis had AUC >= 0.70 in this new sample, and the same SCNS-SF34 item was best discriminated by QLQ-C30 scores. Cutoff scores were identified with sensitivity >= 0.84 and specificity >= 0.54. Conclusion Given these findings' concordance with our previous analysis, these QLQ-C30 cutoffs could be implemented in clinical practice and their usefulness evaluated.
  • Associations of interleukin-6 with vegetative but not affective depressive symptoms in terminally ill cancer patients, Masatoshi Inagaki, Tatsuo Akechi, Toru Okuyama, Yuriko Sugawara, Hiroya Kinoshita, Yasuo Shima, Kimio Terao, Shuichi Mitsunaga, Atsushi Ochiai, Yosuke Uchitomi, SUPPORTIVE CARE IN CANCER, 21, (8) 2097 - 2106,   2013年08月, 査読有り, Previous studies have reported associations of depressive symptoms with pro-inflammatory cytokines, especially with interleukin-6 (IL-6) in noncancer subjects and cancer patients. Meanwhile, symptoms such as tiredness and appetite loss may be vegetative symptoms of depression when associated with other diagnostic criteria of depression. Such vegetative-type symptoms worsen during the last 6 months of life in cancer patients and may not be associated with affective depressive symptoms such as sadness and nervousness. This study explored associations between depressive symptoms and plasma IL-6 in terminally ill cancer patients whose survival period was confirmed to be less than 6 months by follow-up, with attention to differences in vegetative and affective depressive symptoms. Data from 112 consecutively recruited terminally ill cancer patients who registered at a palliative care unit without any active anticancer treatment were used. Plasma IL-6 levels were measured using an electrochemiluminescence assay. Depressive symptoms included in the DSM-IV and Cavanaugh criteria were assessed by structured interviews and were categorized into affective symptoms and vegetative symptoms. Affective symptoms were also measured with the depression subscale of the Hospital Anxiety and Depression Scale, which does not include vegetative symptoms. Vegetative symptoms, such as appetite loss, insomnia, and fatigue, were significantly associated with IL-6 levels. However, neither of the affective symptoms nor their severity was associated with IL-6 levels. IL-6 was associated with vegetative depressive symptoms in terminally ill cancer patients but not with affective depressive symptoms, suggesting possible differences in the pathophysiological mechanisms between these sets of symptoms.
  • Attributing Variance in Supportive Care Needs during Cancer: Culture-Service, and Individual Differences, before Clinical Factors, Richard Fielding, Wendy Wing Tak Lam, Shiow Ching Shun, Toru Okuyama, Yeur Hur Lai, Makoto Wada, Tatsuo Akechi, Wylie Wai Yee Li, PLOS ONE, 8, (5) ,   2013年05月, 査読有り, Background: Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. Methods: Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. Results: All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03-0.001, Bonferroni). Other SCN domains differed only between Chinese and Japanese samples (all p<0.001). Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p, 0.001), followed by age (p = 0.01-0.001) and employment status (p = 0.01-0.001). Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low. Conclusions: Health service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.
  • 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.
  • Problem-Solving Therapy for Psychological Distress in Japanese Early-stage Breast Cancer Patients, Kei Hirai, Hiroko Motooka, Naoshi Ito, Naoko Wada, Arika Yoshizaki, Mariko Shiozaki, Kanae Momino, Toru Okuyama, Tatsuo Akechi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 42, (12) 1168 - 1174,   2012年12月, 査読有り, The current report provides the result of a Phase II clinical trial regarding the effectiveness and feasibility of problem-solving therapy for psychological distress experienced by Japanese early-stage breast cancer patients. Participants were 36 post-surgery Japanese breast cancer patients in a university hospital located in Osaka Prefecture, Japan. After screening for psychological distress using the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale, highly distressed patients were exposed to 5 weekly sessions of the problem-solving therapy program. Nineteen patients completed the intervention and follow-up. There was a significant difference between the pre-intervention and the 3-month follow-up in the total Hospital Anxiety and Depression Scale score (P 0.02), and the mean change score from the pre-intervention to the follow-up was 6.05 (SD 1.94). The intervention had a large effect size (d 0.82). There were also significant changes in worry, self-efficacy and quality of life measures. The findings of our study suggest that the problem-solving therapy program has potential to be effective for alleviating psychological distress experienced by Japanese early-stage breast cancer patients. The true effectiveness of the program should be confirmed by a future randomized control trial.
  • 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.
  • Treatment of delirium with risperidone in cancer patients, Yasuhiro Kishi, Masashi Kato, Toru Okuyama, Steven Thurber, PSYCHIATRY AND CLINICAL NEUROSCIENCES, 66, (5) 411 - 417,   2012年08月, 査読有り, Aim: Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. Methods: The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 +/- 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 +/- 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). Results: Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. Conclusions: Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition.
  • Dignity therapy: Preliminary cross-cultural findings regarding implementation among Japanese advanced cancer patients, Tatsuo Akechi, Terukazu Akazawa, Yasunaga Komori, Tatsuya Morita, Hiroyuki Otani, Takuya Shinjo, Toru Okuyama, Mika Kobayashi, PALLIATIVE MEDICINE, 26, (5) 768 - 769,   2012年07月, 査読有り
  • Good Death in Elderly Adults with Cancer in Japan Based on Perspectives of the General Population, Tatsuo Akechi, Mitsunori Miyashita, Tatsuya Morita, Toru Okuyama, Masaki Sakamoto, Ryuichi Sagawa, Yosuke Uchitomi, JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 60, (2) 271 - 276,   2012年02月, 査読有り, OBJECTIVES: To investigate concepts relevant to a good death in elderly adults with cancer. DESIGN: Cross-sectional. SETTING: Japan. PARTICIPANTS: A national sample of 2,595 adults, including 466 aged 70 to 79. MEASUREMENTS: An anonymous questionnaire covering 18 domains (physical and psychological comfort, dying in a favorite place, good relationship with medical staff, maintaining hope and pleasure, not being a burden to others, good relationship with family, physical and cognitive control, environmental comfort, being respected as an individual, life completion, natural death, preparation for death, role accomplishment and contribution to others, unawareness of death, fighting against cancer, pride and beauty, control over the future, and religious and spiritual comfort) and two additional concepts (pokkuri (sudden death) and omakase (leaving the decisions to a medical expert) was completed. The difference in importance of the concept between two age groups (40-69 and 70-79) was investigated using effect sizes (ESs). RESULTS: Clinically significant differences in the concept of good death were observed for two domains and one component: not being a burden to others (ES = -0.24), role accomplishment and contribution to others (ES = 0.29), and omakase (leaving the decisions to a medical expert; ES = 0.60). CONCLUSION: Only a few differences in the concept of good death existed between elderly and younger adults. When caring for terminally ill elderly Japanese adults, medical staff should acknowledge that some elderly adults value the traditional paternalistic attitude of physicians and that not all people want to be actively involved in decision-making. J Am Geriatr Soc 60: 271-276, 2012.
  • 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.
  • Case of intrathecal baclofen-induced psychotic symptoms, Ryuichi Sagawa, Aiko Yoshida, Tadashi Funayama, Toru Okuyama, Tatsuo Akechi, Toshiaki A. Furukawa, PSYCHIATRY AND CLINICAL NEUROSCIENCES, 65, (3) 300 - 301,   2011年, 査読有り
  • 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).
  • Japanese Version of the Delirium Rating Scale, Revised-98 (DRS-R98-J): Reliability and Validity, Masashi Kato, Yasuhiro Kishi, Toru Okuyama, Paula T. Trzepacz, Takashi Hosaka, PSYCHOSOMATICS, 51, (5) 425 - 431,   2010年09月, 査読有り, Background: Delirium is a common neuropsychiatric disorder in medical and surgical inpatients of all ages. It is associated with increased long-term mortality, longer length of hospital stay, poor functional recovery, and increased likelihood of nursing home placement. Objective: The aim of this study was to investigate the reliability and the validity of the Japanese translation of the Delirium Rating Scale, Revised-98 (DRS-R-98). Method: Psychiatric-consultation patients were assessed to compare groups of delirium, dementia, and non-delirium. Results: Mean Total and Severity scores significantly distinguished delirium from the other groups. The scale had high interrater reliability and high internal consistency. Mean Severity scores during delirium differed from the posttreatment scores. Stratum-specific likelihood ratios showed that the DRS-R98-J is a reliable diagnostic tool. Conclusion: This study indicates that the Japanese version of the DRS-R-98 has high reliability and validity, and is a useful tool for assessing delirium among Japanese medically ill populations. (Psychosomatics 2010; 51: 425-431)
  • Impact of Cultural and Linguistic Factors on Symptom Reporting by Patients With Cancer, Xin Shelley Wang, Charles S. Cleeland, Tito R. Mendoza, Young Ho Yun, Ying Wang, Toru Okuyama, Valen E. Johnson, JOURNAL OF THE NATIONAL CANCER INSTITUTE, 102, (10) 732 - 738,   2010年05月, 査読有り, Background Patient reporting of the severity and impact of symptoms is an essential component of cancer symptom management and cancer treatment clinical trials. In multinational clinical trials, cultural and linguistic variations in patient-reported outcomes instruments could confound the interpretation of study results. Methods The severity and interference of multiple symptoms in 1433 cancer patients with mixed diagnoses and treatment status from the United States, China, Japan, Russia, and Korea were measured with psychometrically validated language versions of the M. D. Anderson Symptom Inventory (MDASI). Mixed-effect ordinal probit regression models were fitted to the pooled data to compare the magnitude of the effect of "country" (nation and linguistic factors) with between-subjects effects on symptom reporting, adjusted for patient and clinical factors (age, sex, performance status, and chemotherapy status). Results For the pooled sample, fatigue, disturbed sleep, distress, pain, and lack of appetite were the most severe patient-reported MDASI symptoms. The magnitude of the variance of the country random effects was only one-fourth to one-half of the interpatient variation (sigma(2) = 0.23-0.46) for all symptoms, except nausea and vomiting. Conclusions Cultural and linguistic variations in symptom reporting among the five language versions of the validated MDASI were limited. Ordinal probit modeling provided a simple mechanism for accounting for cultural and linguistic differences in patient populations. The equivalence among MDASI translations in this study suggests that symptom ratings collected from various cultural and language groups using the MDASI can be interpreted in a similar way in oncology practice, clinical trials, and clinical research.
  • Gender differences in factors associated with suicidal ideation in major depression among cancer patients, Tatsuo Akechi, Hitoshi Okamura, Tomohito Nakano, Nobuya Akizuki, Masako Okamura, Ken Shimizu, Toru Okuyama, Toshiaki A. Furukawa, Yosuke Uchitomi, PSYCHO-ONCOLOGY, 19, (4) 384 - 389,   2010年04月, 査読有り, Objective: Major depression is a well-documented risk factor for suicide, and several gender differences in risk factors for suicide exist in cancer patients as well as in the general population. However, no data is available regarding gender differences in risk factors for suicide among cancer patients with major depression. Methods: We investigated the background differences between cancer patients suffering from major depression with or without suicidal ideation according to gender by analyzing the consultation data obtained for patients referred to the Psychiatry Division. Results: Among the 5431 referred patients, 329 males and 399 females were diagnosed as having major depression; among these patients with major depression, 136 (41%) males and 157 (39%) females also had suicidal ideation. A preliminary analysis showed that physical functioning and an advanced stage were potential factors that interacted significantly with gender differences regarding suicidal ideation. A final logistic regression analysis indicated that poor physical functioning and an advanced stage were significant risk factors among male patients. Conclusions: These preliminary findings suggest that gender differences in important indicators of suicidal ideation exist among cancer patients with major depression; these findings may be useful for developing strategies to prevent suicide among cancer patients. Copyright (C) 2009 John Wiley & Sons, Ltd.
  • A Case with Hodgkin Lymphoma and Fronto-temporal Lobular Degeneration (FTLD)-like Dementia Facilitated by Chemotherapy, Ryuta Katsumata, Ryuichi Sagawa, Tatsuo Akechi, Yoshihiro Shinagawa, Syutaro Nakaaki, Atsushi Inagaki, Toru Okuyama, Terukazu Akazawa, Toshiaki A. Furukawa, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 40, (4) 365 - 368,   2010年04月, 査読有り, We report a case of a 39-year-old man with Hodgkin lymphoma who developed depressive symptoms after starting adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy and later exhibited sexual disinhibition in addition to cognitive dysfunction (mainly executive dysfunction). Seven months after the start of adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy, he was finally diagnosed as having fronto-temporal lobular degeneration-like dementia facilitated by adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy. At the time of writing, the patient's condition has persisted for more than 6 months after the discontinuation of adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy, and the changes in brain function brought on by the adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy may now be irreversible. This case points to the importance of being attentive to the appearance of neuropsychiatric symptoms and evaluating brain functions properly when performing anti-cancer chemotherapy.
  • 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)., Okuyama T, Akechi T, Yamashita H, Toyama T, Endo C, Sagawa R, Uchida M, Furukawa TA, Psycho-oncology, 18, (9) 1003 - 1010,   2009年09月, 査読有り
  • Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study., Okuyama T, Endo C, Seto T, Kato M, Seki N, Akechi T, Furukawa TA, Eguchi K, Hosaka T, Palliative & supportive care, 7, (2) 229 - 233,   2009年06月, 査読有り
  • Symptom indicator of severity of depression in cancer patients: a comparison of the DSM-IV criteria with alternative diagnostic criteria., Akechi T, Ietsugu T, Sukigara M, Okamura H, Nakano T, Akizuki N, Okamura M, Shimizu K, Okuyama T, Furukawa TA, Uchitomi Y, General hospital psychiatry, 31, (3) 225 - 232,   2009年05月, 査読有り
  • Etiologies of delirium and their relationship to reversibility and motor subtype in cancer patients., Sagawa R, Akechi T, Okuyama T, Uchida M, Furukawa TA, Japanese journal of clinical oncology, 39, (3) 175 - 182,   2009年03月, 査読有り
  • Psychosocial factors and survival after diagnosis of inoperable non-small cell lung cancer., Akechi T, Okamura H, Okuyama T, Furukawa TA, Nishiwaki Y, Uchitomi Y, Psycho-oncology, 18, (1) 23 - 29,   2009年01月, 査読有り
  • Problem-solving therapy for psychological distress in Japanese cancer patients: preliminary clinical experience from psychiatric consultations., Akechi T, Hirai K, Motooka H, Shiozaki M, Chen J, Momino K, Okuyama T, Furukawa TA, Japanese journal of clinical oncology, 38, (12) 867 - 870,   2008年12月, 査読有り
  • Patient-perceived barriers to the psychological care of Japanese patients with lung cancer., Endo C, Akechi T, Okuyama T, Seto T, Kato M, Seki N, Eguchi K, Hosaka T, Furukawa TA, Japanese journal of clinical oncology, 38, (10) 653 - 660,   2008年10月, 査読有り
  • Cancer patients' reluctance to disclose their emotional distress to their physicians: a study of Japanese patients with lung cancer., Okuyama T, Endo C, Seto T, Kato M, Seki N, Akechi T, Furukawa TA, Eguchi K, Hosaka T, Psycho-oncology, 17, (5) 460 - 465,   2008年05月, 査読有り
  • Factors correlated with fatigue in terminally ill cancer patients: a longitudinal study., Okuyama T, Akechi T, Shima Y, Sugahara Y, Okamura H, Hosaka T, Furukawa TA, Uchitomi Y, Journal of pain and symptom management, 35, (5) 515 - 523,   2008年05月, 査読有り
  • Plasma interleukin-6 and fatigue in terminally ill cancer patients., Inagaki M, Isono M, Okuyama T, Sugawara Y, Akechi T, Akizuki N, Fujimori M, Mizuno M, Shima Y, Kinoshita H, Uchitomi Y, Journal of pain and symptom management, 35, (2) 153 - 161,   2008年02月, 査読有り
  • A comparison of psychiatric consultation-liaison services between hospitals in the United States and Japan, Yasuhiro Kishi, William H. Meller, Masashi Kato, Steven Thurber, Susan E. Swigart, Toru Okuyama, Katsunaka Mikami, Roger G. Kathol, Takashi Hosaka, Takayuki Aoki, PSYCHOSOMATICS, 48, (6) 517 - 522,   2007年11月, 査読有り, The authors investigated psychiatric consultation in two hospitals, one in the United States, the other in Japan. They examined similarities and differences, and drew inferences on possible cross-cultural values and/or temporary cultural conditions. As compared with the Japanese consultation patients, the Americans had more mood disorders, including anxiety and chemical-dependency problems, in respective diagnostic classifications. Patients in the United States also showed more acute as well as more serious chronic conditions. These differences may relate to disorder base-rates in the respective countries. In general, psychosocial problems emerged as ascendant in Japan, as compared with chemical-dependency difficulties among American patients. The results are discussed in terms of current conditions in Japan that affect the mental health professions, together with attempts by Japanese clinicians to protect collective mores by ascribing causation for disorders to the individual, rather than the societal conditions often invoked in the United States.
  • Associated and predictive factors of sleep disturbance in advanced cancer patients, Tatsuo Akechi, Toru Okuyama, Nobuya Akizuki, Ken Shimizu, Masatoshi Inagaki, Malko Fujimori, Yasuo Shima, Toshiaki A. Furukawa, Yosuke Uchitomi, PSYCHO-ONCOLOGY, 16, (10) 888 - 894,   2007年10月, 査読有り, Little attention has been paid to sleep disturbance experienced by advanced cancer patients. The purpose of the present study was to investigate longitudinal change in sleep disturbance and to identify factors that associated with and predicted sleep disturbance among 209 consecutive terminally ill cancer patients. Patients were assessed twice for sleep disturbance by one item of the structured clinical interview for assessing depression, once at the time of their registration with a palliative care unit (PCU) (baseline) and again at the time of their PCU admission (follow-up), and possible associated medical and psychosocial factors were evaluated. The proportions of patients with obvious sleep disturbance at baseline and follow-up were 15.3 and 25.9%, respectively. Sixty-seven percent of the subjects showed some sleep status changes, including both aggravation and improvement, between baseline and follow-up. Being younger, having diarrhea and living alone were significantly associated with sleep disturbance at baseline, and the increase of psychological distress was the only significant predictive factor for sleep disturbance at follow-up. These findings suggest that psychological distress is a possible key cause of sleep disturbance and management of psychological distress may be one promising strategy for prevention of sleep disturbance among advanced cancer patients. Copyright (C) 2006 John Wiley & Sons, Ltd.
  • Evidence-based guidelines for interpretation of the Hamilton rating scale for depression, Toshi A. Furukawa, Tatsuo Akechi, Hideki Azuma, Toru Okuyama, Teruhiko Higuchi, JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY, 27, (5) 531 - 534,   2007年10月, 査読有り
  • Mental health literacy in Japanese cancer patients: Ability to recognize depression and preferences of treatments-comparison with Japanese lay public, Toru Okuyama, Yoshibumi Nakane, Chiharu Endo, Takashi Seto, Masashi Kato, Nobuhiko Seki, Tatsuo Akechi, Toshiaki A. Furukawa, Kenji Eguchi, Takashi Hosaka, PSYCHO-ONCOLOGY, 16, (9) 834 - 842,   2007年09月, 査読有り, Background: Insufficient knowledge about mental illness and its treatment has been shown to constitute a major barrier to its adequate care for mental illness in the lay public (LP). We therefore examined Japanese cancer patients' (CP) ability to recognize depression and their preferences of its treatments. Participants and Method: One hundred lung CP and 300 LP were selected at random to participate in the study. Structured interviews using a vignette of a person with both cancer and depression were conducted with CP, and those using a vignette of a person with depression were carried out with LP, respectively. Results: Only 11% of CP recognized the presence of depression in the vignette, while 25% of LP did (p < 0.001). There were few significant differences in the preference for standard psychiatric treatments between CP and LP: standard treatments such as antidepressants (CP: 39%, LP: 36%) were less often rated as helpful, whereas non-standard treatments such as physical activity (CP: 85%, LP: 66%) were most often rated as helpful. Conclusions: The results indicated that cancer patients' knowledge about mental illness and its treatment were insufficient. Psychological education may reduce patient-related barriers to seek and to utilize optimal mental health care in cancer patients. Copyright (c) 2006 John Wiley & Sons, Ltd.
  • Delirium: Patient characteristics that predict a missed diagnosis at psychiatric consultation, Yasuhiro Kishi, Masashi Kato, Toru Okuyama, Takashi Hosaka, Katsunaka Mikami, William Meller, Steven Thurber, Roger Kathol, GENERAL HOSPITAL PSYCHIATRY, 29, (5) 442 - 445,   2007年09月, 査読有り, Objective: This study evaluates patient characteristics that might predict a missed diagnosis of delirium prior to being seen by a psychiatric consultant. Method: Study participants were assessed using quantitative standardized scales of cognitive function, delirium and physical impairment. Results: Referring service personnel missed the diagnosis of delirium in 46% of psychiatric consultations. Two factors were associated with their failure to identify delirium accurately: use of a past psychiatric diagnosis to explain delirium symptoms and the presence of pain. Symptoms of delirium and quantitative scale scores did not distinguish between patients with whom diagnosis had been missed and those with accurate diagnoses. Conclusion: The consulting physicians of patients with delirium often incorrectly turn to past psychiatric diagnoses and/or are distracted by the presence of pain and, thus, fail to accurately diagnose delirium. (C) 2007 Elsevier Inc. All rights reserved.
  • Multifaceted psychosocial intervention program for breast cancer patients after first recurrence: Feasibility study, Tatsuo Akechi, Koji Taniguchi, Shimako Suzuki, Masako Okamura, Hironobu Minami, Toru Okuyama, Toshiaki A. Furukawa, Yosuke Uchitomi, PSYCHO-ONCOLOGY, 16, (6) 517 - 524,   2007年06月, 査読有り, We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted. Copyright (c) 2006 John Wiley & Sons, Ltd.
  • Course of psychological distress and its predictors in advanced non-small cell lung cancer patients, Tatsuo Akechi, Toru Okuyama, Nobuya Akizuki, Hideki Azuma, Ryuichi Sagawa, Toshiaki A. Furukawa, Yosuke Uchitomi, PSYCHO-ONCOLOGY, 15, (6) 463 - 473,   2006年06月, 査読有り, This study investigated longitudinal changes and predictive factors for psychologgical distress among 85 newly diagnosed advanced non-small cell lung cancer (NSCLC) patients. Whereas tension-anxiety after diagnosis (T1) was significantly reduced at two months (T2) and six months (T3) after diagnosis and depression-dejection at T1 was significantly reduced at T2. other forms of psychological distress. including anger-hostiltiy. vigor. fatigue. and confusion, did not show significant changes. Total mood disturbance did not show significant change. Only a higher total mood disturbance at T1 was a significant predictor of total mood disturbance at T3. These findings demonstrate that most types of psychological distress experienced by advanced NSCLC patients is likely to persist during the subsequent clinical course. The findings also suggest that initial psychological distress itself after cancer diagnosis is the most important predictor for subsequent psychological distress and that early intervention beginning immediately after the disclosure of a diagnosis of cancer is one way to prevent and/or reduce subsequent psychological distress in advanced NSCLC patients. Copyright (c) 2005 John Wiley & Sons. Ltd.
  • Screening for depression in terminally ill cancer patients in Japan, T Akechi, T Okuyama, Y Sugawara, Y Shima, TA Furukawa, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 31, (1) 5 - 12,   2006年01月, 査読有り, This study attempted to assess the performance of several screening instruments for adjustment disorders (ADs) and major depression (MD) among terminally ill Japanese cancer patients. Two hundred and nine consecutive patients were assessed for ADs and AM using a structured clinical interview at the time of their registration with a palliative care,unit, and two single-item interviews ("Are you depressed?" and "Have you lost interest?") and. the Hospital Anxiety and Depression Scale (HADS) were administered. Screening performance was investigated by calculating sensitivity, specificity, the positive predictive value, negative predictive value, likelihood ratio, and stratum-specific likelihood ratios. When the screening target included both an AD and MD the HADS is a more useful screening method than the single-item. interviews. Regarding screening for MD, both single-item. interviews and the HADS possess useful screening performance. Different screening instruments may be recommended depending on the depressive disorders and specific populations.
  • Occurrence of fatigue and associated factors in disease-free breast cancer patients without depression, Y Sugawara, T Akechi, T Okuyama, Y Matsuoka, T Nakano, M Inagaki, S Imoto, M Fujimori, T Hosaka, Y Uchitomi, SUPPORTIVE CARE IN CANCER, 13, (8) 628 - 636,   2005年08月, 査読有り, Goals of work: Studies 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 methods: Seventy-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 results: We found that 36.7% of the patients exhibited fatigue and that fatigue was significantly associated with neuroticism. Conclusions: These 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.
  • Changes in mental disorder distribution among suicide attempters in mid-west area of Kanagawa, A Ichimura, H Matsumoto, T Kimura, T Okuyama, T Watanabe, Y Nakagawa, Yamamoto, I, S Inokuchi, T Hosaka, PSYCHIATRY AND CLINICAL NEUROSCIENCES, 59, (2) 113 - 118,   2005年04月, 査読有り, To clarify changes in mental disorder distribution in suicide attempters, a comparison was made between the period when an economic recession started (1992, 1993) and the period when the recession became serious (2000). The subjects were 212 suicide attempters admitted to the Emergency Medical Center of Tokai University Hospital during a 2-year period between 1992 and 1993 (group A) and 255 suicide attempters admitted during a 1-year period between January and December 2000 (group B). Mental disorders were classified according to the International Classification of Diseases (10th revision; ICD-10). Distribution was compared between groups A and B and significant differences were observed in mental disorder distribution (P < 0.001). The percentages of subjects with depression, those with neurotic disorders, and those with other disorders were higher in group B than in group A. Conversely, the percentage of subjects with schizophrenia was lower in group B than in group A. Mental disorder distribution in suicide attempters significantly changed. However, it was not certain that this change was related to the economic recession and increased unemployment in Japan.
  • Major depression, adjustment disorders, and post-traumatic stress disorder in terminally Ill cancer patients: Associated and predictive factors, T Akechi, T Okuyama, Y Sugawara, T Nakano, Y Shima, Y Uchitomi, JOURNAL OF CLINICAL ONCOLOGY, 22, (10) 1957 - 1965,   2004年05月, 査読有り, 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 MID 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. (C) 2004 by American Society of Clinical Oncology.
  • Suicidality in terminally ill Japanese patients with cancer - Prevalence, patient perceptions, contributing factors, and longitudinal, T Akechi, T Okuyama, Y Sugawara, T Nakano, Y Shima, Y Uchitomi, CANCER, 100, (1) 183 - 191,   2004年01月, 査読有り, BACKGROUND. 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. METHODS. Consecutive outpatients with cancer who registered with a palliative care unit participated. Structured interviews (e.g., Structured Clinical Interview for DSM-III-R [SCID]) were conducted to assess patient suicidal ideation (Ideation) and interest in requesting euthanasia (Interest) as main outcome measures of suicidality. Possible correlated factors also were investigated. The authors analyzed the data from 140 terminally ill patients with cancer at initial study participation (baseline) whose subsequent survival time was < 6 months. Of these 140 patients, 57 (40.7%) completed the follow-up assessment after admission to the unit. RESULTS. At baseline, 8.6% of the patients had Ideation and 5.0% had Interest. Self-reported anxiety and depression was significantly associated with Ideation (P = 0.003). Changes in Ideation and Interest occurred in 38.6% and 15.8% of the patients, respectively. Ideation was more likely to change than Interest (P = 0.006). The current study did not identify factors that predict changes and occurrences of suicidal ideation and interest in requesting euthanasia. CONCLUSIONS. Suicidality can change even in terminally ill patients. End-of-life care that focuses on the psychologic distress of dying individuals may be a way of preventing suicide. (C) 2003 American Cancer Society.
  • Adequacy of cancer pain management in a Japanese Cancer Hospital, T Okuyama, XS Wang, T Akechi, TR Mendoza, T Hosaka, CS Cleeland, Y Uchitomi, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 34, (1) 37 - 42,   2004年01月, 査読有り, Background: Pain is one of the most frequent and deleterious symptoms in cancer patients. This study was carried out to investigate the adequacy of pain management at the National Cancer Center Hospital East, Japan. Methods: The available data were obtained from 138 ambulatory cancer patients with pain. The data included pain severity, which patients reported using the Japanese version of the M. D. Anderson Symptom Inventory, along with such medical information as cancer and treatment information and currently prescribed analgesics. Adequacy of pain management was assessed using the Pain Management Index, which revealed whether prescribed analgesic drugs were congruent with pain severity. Results: Physicians undertreated pain in 70% of patients. Patients with non-advanced cancer (local cancer or no evidence of any recurrent cancer) were more likely to receive inadequate treatment than those with advanced cancer [P = 0.009, odds ratio = 0.18, Exp (95% CI) lower = 0.05, higher = 0.64] in the exploratory logistic regression analysis. Additionally, we found significant differences among physicians in ability to manage cancer pain, unrelated to a physician's years of experience as an oncologist. Conclusions: This study suggests that cancer pain management is insufficient at the investigated institute. Remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.
  • Japanese version of the MD Anderson symptom inventory: A validation study, T Okuyama, XS Wang, T Akechi, TR Mendoza, T Hosaka, CS Cleeland, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 26, (6) 1093 - 1104,   2003年12月, 査読有り, Cancer patients frequently suffer from a myriad of symptoms. The development and application of comprehensive assessment tools is essential to the effective management of these symptoms. The M.D. Anderson Symptom Inventory (MDASI), developed in English, is a brief, self-rating multiple symptom assessment scale that consists of 13 symptom items and 6 interference items. We examined the validity and reliability of the Japanese version of this scale (MDASI-J) by evaluating 252 randomly selected cancer patients. They were asked to self-administer the MDASI-J and the European Organization for Research and Treatment of Cancer QLQ-C 30. Construct, criterion, convergent and discriminant validity, and reliability of the MDASI-J were evaluated and compared with corresponding data obtained in the previous study conducted in the United States. The results indicated that the MDASI-J is a valid and practical measure for assessing multiple symptoms in Japanese cancer patients. Both factor analysis and cluster analysis showed the consistency of the statistical structure of the English and Japanese versions, indicating the cross-cultural validity of the scale. (C) 2003 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
  • Validation study of the Japanese version of the Brief Fatigue Inventory, T Okuyama, XS Wang, T Akechi, TR Mendoza, T Hosaka, CS Cleeland, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 25, (2) 106 - 117,   2003年02月, 査読有り, Fatigue has been recognized as one of the most distressing symptoms in cancer Patients. Concise assessment is essential to managing this symptom. To that end, the Brief Fatigue Inventory (BFI), a 9-item questionnaire, was designed to assess fatigue in cancer patients. The purpose of this study was to examine the validity and reliability of the Japanese version of this scale (BFI-J), when compared with previously validated fatigue instruments. We randomly selected 252 cancer patients and presented them with the BFI-J, along with the Cancer Fatigue Scale; Profile of Mood States fatigue, vigor, and depression subscales; and European Organization for Research and Treatment of Cancer QLQ-C30. Specifically, the reliability and construct, criterion, convergent, and discriminant validity of each instrument were evaluated. Additionally, fatigue severity classification was explored using the BFI-J. The results indicated that the BFI-J is a brief, valid, and feasible measure of fatigue for use with Japanese cancer patients. J Pain Symptom Manage 2003;25:106-117. (C) 2003 U.S. Cancer Pain Relief Committee. Published by Elsevier Allrights reserved.
  • Prevalence and screening of dyspnea interfering with daily life activities in ambulatory patients with advanced lung cancer, K Tanaka, T Akechi, T Okuyama, Y Nishiwaki, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 23, (6) 484 - 489,   2002年06月, 査読有り, This study aimed to identify the prevalence of clinical dyspnea," defined here as dyspnea interfering with any daily life activities, 2) the impact of dyspnea on daily life activities, 3) the screening ability of the Cancer). Dyspnea Scale (CDS) and the Dyspnea Numeric Scale (DNS). A total of 157 outpatients with advanced lung cancer completed the two scales CDS and DNS) along with a questionnaire about interference with daily life activities (normal work, walking, sleep), mood, relation with other people, enjoyment of life, and general (general activities). Over half of this population (55 %) experienced "clinical dyspnea." Dyspea interfered with not only physical domain. (52 %), such as walking and work, but also with psychological domain (23%), such as mood and enjoyment. Both scales were feasible for screening of clinical dyspnea. Applying a screening protocol, may contribute to avoiding,underestimation clinical dyspnea and lead to appropriate interventions for it. (C) U.S. Cancer Pain Relief Committee, 2002.
  • Factors correlated with dyspnea in advanced lung cancer patients: Organic causes and what else?, K Tanaka, T Akechi, T Okuyama, Y Nishiwaki, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 23, (6) 490 - 500,   2002年06月, 査読有り, This study aimed to correlated with dyspnea in cancer patients among a broad range of medico-psycho-social factors. A total 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 (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 chat-is, 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 might include intervention for psychological distress and pain. (C) U.S. Cancer Pain Relief Committee, 2002.
  • Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer, K Tanaka, T Akechi, T Okuyama, Y Nishiwaki, Y Uchitomi, JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 23, (5) 417 - 423,   2002年05月, 査読有り, This study aimed to compare the impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. Once hundred seventy-one outpatients with advanced lung cancer completed a questionnaire about symptom severity and whether symptoms interferred 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. J Pain Symptom Manage 2002;23:417-423. (C) U.S. Cancer Pain Relief Committee, 2002.

受賞

  •   2019年10月, 日本サイコオンコロジー学会, 第32回日本サイコオンコロジー学会総会ベストポスター賞, 日常臨床で行われている進行がん患者の低活動型せん妄に対する薬物療法は有用でない
  •   2009年, 日本サイコオンコロジー学会 学会賞
  •   2004年, 第51回 米国心身医学会 ベストポスター賞 3位
  •   2001年, 日本総合病院精神医学会 2000年度金子賞 (最優秀論文賞)

競争的資金

  • 実地臨床における支持療法の実装実態及び普及阻害/促進要因に関する研究, 厚生労働省, 厚生労働科学研究費補助金,   2019年08月 - 2021年03月
  • 重篤な身体疾患に罹患した高齢者における、病状悪化に備えた事前意思決定に関する研究, 文部科学省, 科学研究費助成事業 基盤研究C,   2016年04月 - 2020年03月
  • 身体心理学的アプローチを取り入れた看護師のストレスケアプログラムの開発と効果検証, 文部科学省, 科学研究費助成事業 基盤研究C,   2016年04月 - 2019年03月
  • 進行がん患者における病状悪化に備えた事前意思決定に関する多施設研究, 公益財団法人がん研究振興財団, がん研究助成金A,   2016年04月 - 2017年03月
  • がん診断時点の抑うつが一年後の健康効用値に与える影響に関する研究, 公益財団法人愛知県がん研究振興会, 第40回がんその他の悪性新生物研究助成金,   2015年04月 - 2016年03月
  • 血液がん患者のQOL向上を目的とする、新規多職種協働ケアプログラムの開発, 文部科学省, 科学研究費助成事業 基盤研究C,   2012年04月 - 2016年03月
  • 高齢血液がん患者における老年期包括的評価, 名古屋市立大学, 特別研究奨励費,   2011年04月 - 2012年03月
  • 小児・成人がん患者および経験者とその家族の社会的問題に対する支援プログラムの開発に関する研究, 厚生労働省, 科学研究費補助金 がん臨床研究事業,   2011年04月 - 2012年03月
  • 高齢がん患者における心身の状態の包括的評価方法に関する研究, 厚生労働省, 科学研究費補助金 がん臨床研究事業,   2010年04月 - 2012年03月
  • 成人がん患者と小児がん患者の家族に対する望ましい心理社会的支援のあり方に関する研究, 厚生労働省, 科学研究費補助金 がん臨床研究事業,   2010年04月 - 2011年03月
  • がん患者に対するリエゾン的介入や認知行動療法的アプローチなどの精神医学的な介入の有用性に関する研究班 がん患者のせん妄に関する病態解明とそれに基づく早期発見介入パッケージの開発, 厚生労働省, 科学研究費補助金 がん臨床研究事業,   2007年04月 - 2010年03月
  • 主治医による、がん患者の支持的ケアニーズについての認識に関する研究, 文部省, 科学研究費補助金若手研究B,   2006年04月 - 2008年03月
  • がん患者の精神的負担の軽減を目的とするパンフレットの開発に関する研究, 文部省, 科学研究費補助金若手研究B,   2004年04月 - 2006年03月


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