As cancer is a life threatening, patients feel extreme distress and sometime manifest psychiatric disease such as major depression. The needs for psychological care and psycho-oncologist are increasing. Psycho-oncologist is the specialist who have specialty concerning psychiatry or psychosomatic medicine, and also oncology, and can facilitate communication between medical staffs, and enable total care including bio-psycho-social-spiritual aspect. This is in the spirit of psycho-somatic medicine.

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Cancer patients have various kinds of social problems, worries or fears for recurrence or advance of cancer itself. Psychological support for the patients is needed and the effectiveness of several approaches, especially cognitive-behavioral therapy has been shown in previous research. Problem-solving therapy or technique is one of the cognitive-behavioral approaches and supposed to be effective method for the decreasing of psychological distress of the cancer patients. Our study group carried out a phase II clinical trial regarding the effectiveness and feasibility of problem-solving therapy (PST) for psychological distress experienced by Japanese early-stage breast cancer patients. Participants were 36 post-surgery Japanese breast cancer patients. After screening for psychological distress, highly distressed patients were exposed to 5 weekly sessions of the PST program. 19 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 HADS score (p = .02), and the mean change score from pre-intervention to follow-up was 6.05 (SD = 1.94). The intervention had a large effect size (d = .82). There were also significant changes in worry, self-efficacy, and QOL measures. The findings of our study suggest that the PST-based program have potential to be effective for alleviating psychological distress experienced by Japanese cancer patients. The effectiveness and implementation of the therapy in routine clinical setting needs to be future explored.

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It is recommended to provide the palliative care from an initial stage of treatment since "Cancer Control Act" had been enforced in 2007. We believe it is necessary to enhance education of palliative care in University and offer information to doctors for dissemination and awareness rising. Moreover, we need to put the effort for improvement of palliative care education and its internship system. The act of educating palliative care has gradually heightened in school of medicine. Toho University school of medicine also provides the lectures of team medical care, palliative care team, palliative care, and psycho-oncology. However, the lecture contents about the palliative care are various as they are left to the policy of each teacher. We believed there is a necessity to have systematic actions which include examination of the lecture form and cooperation between teachers. In this research, author requested 4^th grade university students to answer questionnaire during a course of palliative care team. According to the result, over 60% of them were interested in palliative care, yet many of them also answered having unclear view of it. It is necessary to prepare and organize curriculum of palliative care based on their opinions.

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In this study, we investigated whether workplace factors such as job stressors and stress reactions were important determinants of leisure-time physical activity as well as self-efficacy, outcome expectation, social support, and environmental factors. A cross-sectional survey with a questionnaire that included leisure-time physical activity, self-efficacy, outcome expectation, social support from family and friends, environmental factors, and workplace factors was administered to 302 workers. Data analyses were conducted using structural equation modeling, creating a model that explained leisure-time physical activity. The results indicated that self-efficacy and outcome expectation mediated the relationships between environmental factors, social support, and leisure-time physical activity. Environmental factors also had a direct effect on leisure-time physical activity. Stress reactions evoked from job stressors had significant negative relationships with outcome expectation. However, job stressors had positive relationships with self-efficacy and pros (expectations of positive outcomes of physical activity). We concluded that environmental factors and social support from external resources are important to increase self-efficacy, decrease cons, and promote leisure-time physical activity. Of workplace factors, job stressors may have both functions to decrease leisure-time physical activity through increasing stress reactions and to increase leisure-time physical activity as coping with job stressors.

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