Independent Validation of the Japanese Version of the EORTC QLQ-C15-PAL for Patients With Advanced Cancer.

CONTEXT: Although the psychometric properties of the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL) have been examined previously, that study had several limitations, for example, small sample size. OBJECTIVES: To examine the validity and reliability, including test-retest reliability, of the Japanese version of EORTC QLQ-C15-PAL for cancer patients with metastasis or recurrence. METHODS: A cross-sectional anonymous questionnaire was administered to cancer patients who were being treated on an oncology inpatient ward, in an oncology outpatient clinic, and in seven inpatient palliative units in Japan, from August 2007 to March 2008. RESULTS: Data from a total of 312 cancer patients were analyzed. The proportion of missing values was less than 4% for all items. The factor structure was reproduced identically with the original EORTC QLQ-C15-PAL, English version. The correlation of subscales showed a reasonable matrix. Cronbach's alpha coefficients were 0.76 to 0.86, and intraclass correlation coefficients, which indicate test-retest reliability, ranged from 0.52 to 0.77. All subscales, especially physical functioning, fatigue, and pain, were significantly correlated with self-reported Eastern Cooperative Oncology Group performance status. CONCLUSION: The Japanese version of EORTC QLQ-C15-PAL has sufficient validity, acceptable reliability, and feasibility for patients with advanced cancer.

Psychologists involved in cancer palliative care in Japan: A nationwide survey.

OBJECTIVE: The aim of this study was to clarify, using a nationwide survey, what is perceived as necessary knowledge and skills for psychologists involved in cancer palliative care in Japan, the expectations of medical staff members, and the degree to which these expectations are met. METHOD: We conducted a questionnaire survey of psychologists involved in cancer palliative care. A total of 419 psychologists from 403 facilities were asked to fill out the questionnaire and return it anonymously. Some 401 psychologists (89 males, 310 females, and 2 unspecified; mean age, 37.2 ± 9.5 years) responded about necessary knowledge and skills for psychologists working in cancer palliative care, the necessity for training, expectations at their current workplace, and the degree to which expectations are met. RESULTS: More than 90% of participants responded that many kinds of knowledge and skills related to the field of cancer palliative care are necessary. Over 80% of participants indicated a necessity for training related to these knowledge and skills. Although more than 50% (range, 50.1-85.8%) of participants responded that such services as "cooperation with medical staff within a hospital," "handling patients for whom psychological support would be beneficial," and "assessment of patients' mental state" were expected at their workplace, fewer than 60% (31.4-56.9%) responded that they actually performed these roles. SIGNIFICANCE OF RESULTS: Our results show that many psychologists in cancer palliative care feel unable to respond to the expectations at their current workplace and that they require more adequate knowledge and skills related to cancer palliative care to work effectively. No other nationwide surveys have generated this type of information in Japan, so we believe that the results of our study are uniquely important.

Troubles and hardships faced by psychologists in cancer care.

OBJECTIVE: The aim of this study was to identify problems experienced by psychologists involved in cancer and palliative care and consider an education system for psychologists. METHODS: We conducted a questionnaire survey of psychologists involved in cancer care and palliative care. At the 403 facilities, 419 psychologists who received the questionnaire were asked to fill it out anonymously. A total of 294 people (61 male, 233 female, average age ± SD = 36.3 ± 9.4) responded about troubles and hardships actually faced by psychologists working in cancer care. We performed qualitative content analysis of free responses. RESULTS: We obtained the following five categories: 'Hospital system', 'Psychologist role and specialization (ambiguity of the role expected of psychologists and problems arising because psychologists are not nationally licensed)', 'Collaboration with other medical professionals (problems with the method of requesting psychologist cooperation and problems of consultation and liaison work within the hospital)', 'Specialized support provided by psychologists (difficulty of interaction with patients and their families, inadequate provision of psychological support in cancer care, problems related to death care and lack of psychiatric knowledge)', 'Stress faced by psychologists (psychologist's isolation and anxiety, psychologist's internal conflicts, psychologist burnout and helplessness and psychologist self-improvement)'. CONCLUSIONS: Psychologists must acquire at least a minimal level of medical knowledge and understanding of cancer treatment. Furthermore, they require training through specific case studies in order to facilitate collaboration with other medical professionals and concrete training in aspects of psychological support that are specifically tailored to cancer treatment through case studies.

Psychological distress of the bereaved seeking medical counseling at a cancer center.

OBJECTIVE: The death of a loved one is one of the most stressful events in life and is related to the physical and psychological wellbeing of the bereaved. Some bereaved individuals seek medical counseling to alleviate their distress. However, no studies have focused on the bereaved who have lost a loved one to cancer and have asked for medical help at a cancer center as a result. The aim of this study was to investigate the distress of the bereaved who sought consultation, as basic information for considering support. METHODS: We conducted a survey of people consulting outpatient services for bereaved families between April 2007 and September 2009. Data were obtained from medical records at initial consultation and qualitatively analyzed by content analysis using all statements related to their distress. RESULTS: Their statements were classified into 11 categories, which were further classified into six themes. The main categories of bereavement-related distress were as follows: (i) regret; (ii) anger; (iii) memories; (iv) loneliness; (v) anxiety; and (vi) hopelessness. 'Regret' was frequently recognized in their distress and it includes some points related to the cancer trajectory. CONCLUSIONS: Psychological distresses of the bereaved who have lost a loved one and have asked for medical counseling are revealed. Their distresses are strongly related to the cancer trajectory of a family member. Some of these distresses are related to medical misunderstanding about the course of cancer. These findings might provide basic information for considering their appropriate treatment.

Psychiatric disorders in cancer patients at a university hospital in Japan: descriptive analysis of 765 psychiatric referrals.

OBJECTIVE: In cancer patients, adjustment disorders, delirium and depression have been identified as common psychiatric disorders. Although a comparable result was reported in the National Cancer Center in Japan, the nature of patients in that hospital may differ from that in local hospitals. There is a possibility to expand the findings of psycho-oncology by evaluation of the data from a local university hospital and comparison with the National Cancer Center data. METHODS: We retrospectively reviewed the medical records of cancer patients who were referred to the Department of Psycho-Oncology at Saitama Medical University International Medical Center. We identified their characteristics and psychiatric diagnoses and compared these with the National Cancer Center data. RESULTS: During the study period, 765 cancer patients were referred. The numbers of inpatients and outpatients were almost the same. The most common psychiatric diagnosis was adjustment disorders (24%), followed by delirium (16%) and then major depressive disorder (12%). The rank of these three was the same as that at the National Cancer Center. Outpatients constituted more than 80% of the patients with major depressive disorder. The proportion of cancer patients with schizophrenia in this study (4.3%) was higher than that in the National Cancer Center (1.6%). CONCLUSIONS: This study revealed basic information about the consultation data of cancer patients at a local university hospital in Japan. The importance of communication with outpatients was suggested. It seems that cancer treatment for patients with schizophrenia in a local hospital is also important.