Previous studies examining the association between personality and cancer incidence or mortality have reported inconsistent findings. During June through August 1990, 30, 277 residents of Miyagi Prefecture in northern Japan completed the Japanese version of the short-form Eysenck Personality Questionnaire-Revised and another questionnaire on various health habits. During 7 years of follow-up until December 1997, we identified 986 incident cases of cancer. We used Cox regression to estimate the relative risk of total cancer according to the four levels of four personality subscales (extraversion, neuroticism, psychoticism, and lie) , with adjustment for sex, age, education, smoking, drinking, body mass index, and family history of cancer. Multivariate relative risks for the highest verses the lowest level of personality subscales were 0.9 for extraversion (95 percent confidence interval, 0.7-1.1 ; trend p=0.32), 1.1 for psychoticism (95 percent confidence interval, 0.9-1.3 ; trend p=0.96), 0.9 for lie (95 percent confidence interval, 0.7-1.0 ; trend p=0.19), and 1.2 for neuroticism (95 percent confidence interval, 1.0-1.4 ; trend p=0.06). Although neuroticism showed significant, positive, linear associations with 671 cancer cases prevalent at baseline (trend p<0.001) and with 320 cases diagnosed within the first three years of follow-up (trend p=0.03), it showed no association with 666 cases diagnosed during the fourth through the seventh years of follow-up (trend p=0.43). This prospective study does not support hypothesis that personality is a risk factor for cancer incidence. The association between neuroticism and prevalent cases of cancer seems to be a consequence, rather than a cause, of the diagnosis or symptoms of cancer.

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Twenty-eight terminally ill cancer patients, whose prognoses were diagnosed poor by oncology specialists, were treated comprehensively by complementary agents and logotherapeutic approaches. The effects were evaluated retrospectively. They were evaluated subjectively by a QOL questionnaire and objectively by urine 17-KS-S (abbreviated to S), 17-OHCS (OH) and S/OH ratio. Supplementary agents of Juzentaihoto (Shi-Quan-Da-Bu-Tang), Korean red ginseng and coenzyme Q 10 were administered and the psychotherapy based on logotherapy (existential analysis) was performed. Prolongation of lives and improvement of QOL were observed (less than 6 months to 18 months). Their lower S and S/OH ratio increased. Among them 6 cases showed an existential shift (shift group). In the shift group and the non-shift group, the biopsychosocial and existential conditions were examined. Total-QOL, appetite, high S value, supreme experience, awareness of meaning of lives showed higher scores in the shift group than in the non-shift group. Dying with dignity was more apparent in the shift group.

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Positron emission tomography (PET) is a highly advanced form of scintigraphy, invented for observation of regional tissue activity : glucose and oxygen consumptions, regional blood flow, neurotransmitter-receptor interactions in any part of human body. PET is currently in use not only for cancer diagnosis but also for evaluation of brain activity. Surely this functional imaging is also applicable to brain activity of cancer patients with depression. In this paper, basic concepts and techniques of PET neuroimaging in cancer patients will be overviewed, putting emphasis on its possible impacts to the field of psycho-oncology. In our study, 80 Japanese cancer patients without brain metastasis were studied with PET and ^<18>F-fluorodeoxyglucose (FDG). Regional cerebral metabolism was examined by applying statistical parametric mapping (SPM) software on their brain image extracted from their whole-body images. The brain image data of cancer patients without experience of chemotherapy were selected (19 patients) and were compared to the benign patients group. The results showed that cancer patients demonstrated decreased regional brain activity in the cingulate gyrus, prefrontal cortex, orbitofrontal cortex and so on. This finding was grossly reproduced in German cancer patients later, where 20 patients without brain metastasis were scanned by FDG-PET. Self-rating depression scales (SDS) were assigned to 16 of these patients just after the PET scanning. Cancer patients were sub-grouped by SDS scores. Comparisons were conducted between the normal and cancer patients with and without depression. The results showed that several regions were hypometabolic such as the bilateral basolateral frontal cortices, anterior and posterior cingulate gyri and right insular cortex as well as the bilateral basal ganglia, prefrontal cortices, premotor cortices and frontal eye fields. Parietal cortices also showed decreased metabolism. These regions were in accordance with our previously-reported studies on depression. These findings of hypometabolism were more intense in cancer patients with depression than those without. These results suggest that cancer patients without brain metastasis manifest abnormality in the regional cerebral metabolism and that the abnormalities in the regional metabolism may be related with their degrees of emotional disturbances. PET brain mapping of cancer patients might supply a new objective biological marker for clinical evaluation in the field of psycho-oncology.

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Family members of a cancer patient should be recognized as "second-order patients," because the diagnosis of cancer in a family member presents a frightening crisis to the whole family and all of the family members react in their characteristic ways. Nevertheless, most of Japanese medical oncologists seem to take it for granted that the family would be available as an extended agent of patient care and the important cancer information is often varied, according to family members. Moreover, in trying to protect themselves and the patient, many families reduce the communication process and create a "conspiracy of silence," which has already been well documented in the past Western literature. There are no such family intervention programs in today's Japan that have any evidence to improve family functioning of cancer patients. In this article, we review the available literature referring to family issues in cancer care with a view to clarifying the central role of the family and developing a comprehensive approach to family intervention. Also, we refer to effective skills of communication with cancer patients and their family members.

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It is reported that common psychiatric disorders in cancer patients are adjustment disorder and major depression, and that multiple factors contribute to the development of these disorders. Effectiveness of antidepressants for major depression in cancer patients have been clarified by several randomized clinical controlled trials. In addition, psychotherapies are also suggested to be useful for reducing psychological distress experienced by cancer patients. It is reported that early detection of psychiatric disorders is important in the clinical oncology setting. These findings suggest that individually tailored comprehensive intervention including early detection and identifying underlying causes of psychological distress, pharmacotherapy and psychotherapy is a promising strategy for ameliorating psychological distress in cancer patients. National Cancer Center developed the patient support program as an individually tailored multifaceted intervention.

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Psychologists play important roles in the clinical practice of psychiatry. However, they are faced with several problems in their activities at the department of psychiatry, of the university hospital. The main problems are as follows ; (1) although psychologists are essential members in clinical practice, their position is not well established, (2) they are required to have medical knowledge, because they are considerd as the medical staff of the university hospital from the patients point of view, (3) when psychologists treat the patients, they need to keep close communication with physicians in charge in order to bear their share of the responsibility.

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