Recent advances in anticancer treatment have improved the clinical outcomes of cancer patients, especially with advanced diseases. However, more efforts should be made toward psychosomatic aspects of cancer patients, which rarely been paid attention as cancer biology. There has been an urgent need for training oncologists who have the ability to treat physical, psychological, social, and spiritual pain of cancer patients, as well as to provide optimal anticancer treatment in accordance with evidence based medicine. Therefore, psychosomatic medicine and clinical psychology should be effectively integrated to the conventional training system for physicians to brush up their communication skill and to practice narrative based medicine. In this article, we discussed the potential and the role of psychosomatic medicine in cancer treatment, focusing on palliative care, communication, and therapeutic self.

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Since Basic Law for Anticancer started to be effective in April 2007, the circumstance on the field of psycho-oncology has dramatically changed quantitatively and qualitatively. Nurses can be involved with psychosomatic care of cancer patients and their families on a daily basis. Thus, their role is important. Specific skills are, however, required to pick up important signs and make an adequate assessment of mental status on these patients and their family. Training will be needed to perform psychosomatic care with specialized nursing skill. In the field of oncology, psychiatric liaison mental health nurses can utilize their specialized knowledge and skill to embody the physical and mental health care. In reality, however, only few nurses have the opportunity to nestle close to the cancer patients and their families. Therefore, these liaison nurses have the important task to hand down their knowledge and skill on psychosomatic care to general nurses.

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Objective : To assess the contributing elements for peaceful death of terminally ill patients who received our home-based palliative care at Nakajima Hospice and Clinic in Tokyo. The focus is on the role and efficacy of clinical spiritual care and counseling offered by the staff chaplain and members of the medical team. Method : Questionnaire survey on written responses from key-persons among the bereaved family members. 311 individuals, 31.6%, responded of total 985 cases surveyed, in 90% of cancer. These cases had been accumulated from April 1995 to April 2014. The content of the questionnaire to be answered emphasized the four elements of the Total Pain including the spiritual pain elements. Result : 91.8% responded to “Highly peaceful death or peaceful on the whole.” The relieving level of pain elements for all four categories of Total Pain resulted as ; the spiritual 55.7% ; the mental 73.5% ; the physical 85.4% ; the social 88.8%. The correlationship between “Alleviation of spiritual pain” and “peaceful death” scored p<0.001. Spiritual care given specifically by Chaplain was recognized as “very useful or useful” by 74.8%, that has correlationship with those who perceived the death “very peaceful” and “peaceful” in score of p=0.021. Conclusion : Significant alleviation of spiritual pain elements is highly necessary for supporting the peaceful death. Though this spiritual care is to be given by any trained members of the team, professional chaplaincy is expected to take effective role of resource person and leadership in this area.

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The objective of this study is to assess the efficacy of interventional spiritual-care of terminally ill patients for their peaceful death. A case analysis is done for this study of an 85 year-old female patient with osteosarcoma associated with severe phantom sensation and pain immediately followed the amputation from her left hip joint for a year. Since the case is based on the clinical pastoral care and counseling offered by a chaplain/theologian specialized in terminal care of the dying, the discussion on the relationship between the spiritual counseling and the neuro-physiological mechanism of phantom pain and sensation is not included. Through all the 306-day of her suffering, including the last 36 days of home-based palliative care, none of pain control with opioid by a specialist was effective. The spiritual counselor focused on her notable spiritual pain elements of her total pain such as guilt, loss and fear of death. The utilized resource of the care included listening, prayers, singing hymns, shift of the view of death and suffering. As the result, the phantom pain and sensation markedly disappeared, that enabled her to perfect her own life in her last 104 days with good quality of life to peaceful death. The spiritual care/counseling applied by qualified chaplains proves its vital role in cure of the total pain of the dying. The discussion includes some ethical principles of interventional spiritual care and counseling for the dying suggested by this case in the context of psychosomatic medicine.

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Cancer patients suffer from a variety of pains. In the workshop of cancer care and palliative medicine, we have more opportunities today to learn the mental support to cancer patients than in the past. We also see the increased level of mental support by the medical staff. On the other hand, when mentally weak patients are diagnosed as cancer, they tend to become the risk of suicidal ideas or behaviors (for example, mental patients having difficulties such as developmental delay, personality and emotional problems, etc). Mental burdens such as accustomed pains, death of familiar people, no place to live, inconvenience to others bring a considerable decline of QOL and are perceived as reinforced psychological problems. The psychiatric staff members are requested to play an important role to give professional support to these people.

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In addition to those providing medical assistance, many organizations and institutions went to the disaster area to provide mental health care following the Great East Japan Earthquake. However it became clear that the lack of predefined methods and guidelines resulted in unneeded activity and an uneven distribution of care, and so these became points for future improvement. In order to tackle these shortfalls a new specialist organization, Disaster Psychiatric Assistance Team : DPAT, be able to support the psychiatric care and psychiatric social care in disaster areas, was created on the 1st April 2013. I would like to explore this in further detail, as well as discuss the future prospects of disaster psychiatry.

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We reported the support of Japanese Society of Psychosomatic Pediatrics for disaster affected areas after the Great East Japan Earthquake and Tsunami in 2011. At the same time, we reviewed all the support from professional associations such as academic societies. Whether or not support was effective depended on how supporters evaluated the present needs in the disaster affected areas. Many professional associations tended to offer their specialty at the beginning of their action to support. However, even they may have effectively utilized their knowledge and expertise, most people who lived in the affected areas needed general physicians such as public health doctors. We observed many kinds of group dynamics that took place in the disaster affected areas : promoting social gatherings and encouraging excessive caution. In some areas, residents made a barrier against outside supporters because they felt some threats which might break their own system. It is recommended that supporters make efforts to evaluate the present situation and needs of disaster affected areas in order to provide appropriate aid and to consider that every help provided for a rapid recovery is influenced by the time spent to respond after a massive disaster. The most important key of disaster support is a good structure that can assess the present needs and situation of disaster-affected areas and deliver support that matches them.

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Objectives : The Public Health Research Foundation Stress Checklist (Short Form) (PHRF-SCL (SF) hereinafter) is a scale for measuring stress response in adults. It consists of four subscales ( “Feelings of Anxiety and Uncertainty”, “Fatigue and Physical Symptoms”, “Autonomic Symptoms”, and “Feelings of Depression and Inadequacy”), and has been verified in terms of reliability and validity. On the other hand, egograms have been shown to be associated with mental health and physical disorders. Therefore, in order to confirm the construct validity of PHRF-SCL (SF), we examined its association with Self-growth Egogram (SGE hereinafter). Subjects : 233 patients visiting the department of psychosomatic medicine Method : Subjects were requested to complete a PHRF-SCL (SF) and SGE. Results : Four separate clusters were abstracted from a cluster analysis of SGE results, namely “High-A ‘W’ Type”, “Low-A ‘M’ Type”, “Low-FC ‘V’ Type”, and “High NP ‘へ’ Type”. For each type, we calculated the deviation value for each subscale of the PHRF-SCL (SF) and examined the difference in average using a one-way analysis of variance. The results showed that all stress responses for the “Low-FC ‘V’ Type” were higher than the other types, and that those for the “High-NP ‘ヘ’ Type” were lower than the other types. In addition, whereas the “High-A ‘W’ Type” scored high for “Feelings of Anxiety and Uncertainty” and “Feelings of Depression and Inadequacy” and scored average for “Autonomic Symptoms” and “Fatigue and Physical Symptoms”, the “Low-A ‘M’ Type” scored low for “Feelings of Anxiety and Uncertainty” and “Feelings of Depression and Inadequacy” even though scores for “Autonomic Symptoms” and “Physical Symptoms of Fatigue” were also average. Conclusion : A relationship was observed between stress response and ego-state as revealed by SGE, which was consistent with previous studies. The construct validity of the PHRF-SCL (SF) was thus partially verified.

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