Liaison palliative care team activities in consultation-liaison psychiatry and symptom management in a specialized cancer hospital in Japan

Abstract

A second palliative care team (PCT) was established at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research on June 1, 2012. Known as the Liaison PCT, this team took over consultation-liaison psychiatry services. Of the 228 consecutive referrals to the Liaison PCT from its establishment until February 28, 2013, 97 (43%) were men, and the mean (SD) age was 60.1 years (13.7). Their psychiatric diagnoses included adjustment disorder (59 patients; 25.9%), delirium (52; 22.8%), alcoholism (29; 12.7%), mood disorders (28; 12.3%), acute stress disorder (20; 8.8%), other anxiety disorders (10; 4.4%), dementia (8; 3.5%), schizophrenia (5; 2.2%), and other disorders (17; 7.5%) (e.g., sleep disorder and akathisia). Symptom evaluation in patients with cancer is often difficult, as appetite loss, apathy, insomnia, fatigue, and depression are common effects of the cancer, its treatment (e.g., chemotherapy and radiation therapy), and mental illnesses such as mood or cognitive disorders. If depression with suicidal ideation were present in cancer patients, it would be crucial for clinicians to be skilled in appropriately assessing and relieving uncontrolled suffering. PCTs are required to solve such heterogeneous problems, especially delirium. General hospitals have an advantage in that they can conduct multidisciplinary, collaborative team care with symptom management as the common goal. PCTs trained in treating pain, depression, and delirium will be essential in caring for the super-aging population of Japan, as this care will require a psychosomatic approach.