Abstract
Dear Editor:
This study aimed to describe the current situations of hospitalized schizophrenic patients with cancer in one administrative region in Japan.
Approach
Survey forms, asking the patients' (1) gender, (2) age, (3) length of hospitalization, (4) site of cancer, (5) development, and (6) cancer notification, were distributed to eight psychiatric hospitals in 1 of 47 administrative regions, termed Prefectures, in Japan.
Results
There are a total of 2419 beds for psychiatric inpatients in Prefecture A, of which specialized psychiatric hospitals account for 1968 beds (81.6%). Ninety patients, 44 males (48.9%) and 46 females (51.1%), were identified with the survey. All of them were 30 years old or older, and 60–69 years being the largest age bracket for both male and female patients. Chronic schizophrenia in patients aged 60 to 80 and who had been hospitalized for 6 years or longer accounted for more than 50% of the total.
About 7% of the schizophrenic patients had cancer. As for cancer notification, 26 male patients (59.1%) and 16 female patients (34.8%) were informed of cancer. Forty-five (50%) cancer patients received no treatment. Psychiatrists more often gave explanations on cancer conditions to patients under prolonged hospitalization of six years or longer.
Discussion and Conclusion
The cancer notification rate at specialized psychiatric hospitals in Prefecture A is rather low, and there is not much discussion about this fact either.
1
This is important because it appears that:
(1) Even when a hospitalized schizophrenic patient has developed cancer, psychiatric symptoms of the patient are given first priority, and the cancer stage and cancer treatment options are given low priority. (2) Specialized psychiatric hospitals, with a limited number of doctors and nurses owing to the Psychiatric Service Exception, suffer a constant shortage of healthcare personnel. When a schizophrenic patient develops cancer, a decision as to what to do about the patient is left up to each psychiatric hospital, and this obscures the cancer treatment issues. (3) There has not been much discussion at specialized psychiatric hospitals about letting schizophrenic patients with end-stage cancer die without being given any cancer treatment, although this is where there is a need for palliative care.
Implications for Practice
In addition to the need for active discussion on how to inform psychiatric patients that they have cancer, the nurses at specialized psychiatric hospitals need to acquire improved knowledge and skills to conduct the key elements of palliative care.