Background: Early palliative intervention in advanced cancer patients with metastatic nonsmall-cell-lung cancer has been shown to improve survival time. Possibly, palliative intervention at the time of outpatient care further improves patient survival time.Objective: We performed a comparative study of late and early referrals of patients with advanced cancer to clarify the appropriate time for palliative intervention and the improvement in survival time. Methods: Two hundred and one cancer patients, all since deceased, who were treated in our department over a period of 4 years were divided into two groups: patients who experienced outpatient services for ,7 days (late referral group, 64 patients) and those who experienced outpatient services for 7 days (early referral group, 137 patients). Survival time, duration of chemotherapy and post-progression survival were retrospectively analyzed through examination of medical records. Results: Survival time of the early referral group was longer than that of the late referral group in all the cases (19.0 vs. 6.5 months, P , 0.001). Survival time in advanced non-small-cell lung cancer was 3.5 and 14.0 months (P ¼ 0.010) and 16.5 and 20.9 months (P ¼ 0.039) in advanced colorectal cancer, respectively. There was no significant difference in gastric cancer (P ¼ 0.310). Post-progression survival in each group was 0.7 and 2.7 months (P ¼ 0.018) in non-small-cell lung cancer. Conclusions: The results of this study suggested that early outpatient referral and palliative intervention leads to improvement of the outcome in patients with advanced non-small-cell lung cancer and colorectal cancer. A prospective comparative study is warranted.

The psychological problems of non-Japanese people are becoming more outstanding, in accordance with the increase of foreign nationals in Japan. Five illustrative cases of English-speaking patients were analyzed, from the viewpoint of psychosomatic medicine. The most common psychiatric disorders were adjustment disorders, because of the cultural differences and language barriers.