Akizuki Nobuya
Department of Psycho-oncology, Chiba Cancer Center.
Seishin Shinkeigaku Zasshi. 2010;112(12):1210-5.
With cancer the leading cause of death in Japan since 1981, the cancer care medical system is a critical issue. Psycho-oncology is expected to play an important role in cancer care. The "Basic Plan to Promote Cancer Control Programs" was launched in 2007 under the Cancer Control Act, and it noted the need to increase the number of psycho-oncologists in order to promote palliative care in the early phases of cancer treatment. Additionally, guidelines for new cancer care systems incorporating psychiatrists were established; these guidelines included provisions stipulating that designated cancer care hospitals should have psychiatry departments, and that palliative care teams including psychiatrists were to be covered by insurance. This report describes the first year of operation of the newly established psycho-oncology department at the Chiba Cancer Center. The primary clinical activities of the psycho-oncology department comprise psychiatric consultations for inpatients and psychiatric care for outpatients with cancer and their family caregivers; there is no psychiatric ward. More than half of referred patient were diagnosed with adjustment disorders, major depression, or normal reactions. These patients required support in connection with the psychological adjustment to cancer distress or rehabilitation. The education and training of hospital staff and community medical staff is another role for psycho-oncology. In one palliative care training program, a psycho-oncologist directed the psychological symptoms management module and medical communications module. Psychiatrists at cancer centers or designated cancer care hospitals are expected to play multiple roles in the care of cancer patients and their families. They are occasionally unable to meet these expectations, however, due to a lack of understanding by hospital administrators, lack of time to spend on activities other than standard psychiatric services, and, in the case of some psychiatrists, a lack of interest in cancer care. It is important to develop a realistic and effective medical model of cancer care that includes psychiatrists. Training psychiatrists in psycho-oncology is also an important issue.
自1981年以来，癌症一直是日本的主要死因，癌症护理医疗系统是一个关键问题。心理肿瘤学有望在癌症护理中发挥重要作用。2007年根据《癌症控制法》启动了“促进癌症控制计划基本计划”，该计划指出需要增加心理肿瘤学家的数量，以便在癌症治疗的早期阶段促进姑息治疗。此外，还制定了纳入精神科医生的新癌症护理系统指南；这些指南规定，指定的癌症护理医院应设有精神科，包括精神科医生在内的姑息治疗团队应纳入保险范围。本报告介绍了千叶癌症中心新成立的心理肿瘤学部的运营第一年。心理肿瘤学部的主要临床活动包括为住院患者提供精神科咨询，以及为癌症门诊患者及其家庭护理人员提供精神科护理；该部门没有精神科病房。超过一半的转诊患者被诊断为适应障碍、重度抑郁症或正常反应。这些患者在心理上适应癌症困扰或康复方面需要支持。对医院工作人员和社区医务人员的教育和培训是心理肿瘤学的另一项职责。在一个姑息治疗培训项目中，一名心理肿瘤学家负责指导心理症状管理模块和医疗沟通模块。癌症中心或指定癌症护理医院的精神科医生有望在癌症患者及其家属的护理中发挥多种作用。然而，由于医院管理人员缺乏理解、缺乏时间从事标准精神科服务以外的活动，以及一些精神科医生对癌症护理缺乏兴趣，他们有时无法满足这些期望。建立一个包括精神科医生在内的现实有效的癌症护理医学模式非常重要。对精神科医生进行心理肿瘤学培训也是一个重要问题。
