[The role of psycho-oncology in cancer care in Japan].

With cancer the leading cause of death in Japan since 1981, the cancer care medical system is a critical issue. Psycho-oncology is expected to play an important role in cancer care. The "Basic Plan to Promote Cancer Control Programs" was launched in 2007 under the Cancer Control Act, and it noted the need to increase the number of psycho-oncologists in order to promote palliative care in the early phases of cancer treatment. Additionally, guidelines for new cancer care systems incorporating psychiatrists were established; these guidelines included provisions stipulating that designated cancer care hospitals should have psychiatry departments, and that palliative care teams including psychiatrists were to be covered by insurance. This report describes the first year of operation of the newly established psycho-oncology department at the Chiba Cancer Center. The primary clinical activities of the psycho-oncology department comprise psychiatric consultations for inpatients and psychiatric care for outpatients with cancer and their family caregivers; there is no psychiatric ward. More than half of referred patient were diagnosed with adjustment disorders, major depression, or normal reactions. These patients required support in connection with the psychological adjustment to cancer distress or rehabilitation. The education and training of hospital staff and community medical staff is another role for psycho-oncology. In one palliative care training program, a psycho-oncologist directed the psychological symptoms management module and medical communications module. Psychiatrists at cancer centers or designated cancer care hospitals are expected to play multiple roles in the care of cancer patients and their families. They are occasionally unable to meet these expectations, however, due to a lack of understanding by hospital administrators, lack of time to spend on activities other than standard psychiatric services, and, in the case of some psychiatrists, a lack of interest in cancer care. It is important to develop a realistic and effective medical model of cancer care that includes psychiatrists. Training psychiatrists in psycho-oncology is also an important issue.