title: Gender differences in cancer-related distress in Japan: a retrospective observation study.
abstract: BACKGROUND
  Cancer care is currently the most important medical issue in Japan. Total pain of cancer patients consists of a combination of four factors: physical, psychological, social distress, and spiritual pain. Previous studies showed female cancer patients ask for more psychological support and seem to suffer different types of distress compared with male patients, for example, appearance-related symptoms. However, other factors of cancer distress related to gender have not been defined comprehensively. The aim of this study is to clarify the gender differences in cancer distress types in order to elucidate the measures that should be taken in Japan to improve the quality of whole cancer care based on gender-based medicine.
  
  
  METHODS
  The data of new patients who had visited the psycho-oncology outpatient service of Kinki University Hospital during the period of May 2013 to October 2015 were collected. Demographic factors and all assessed items were extracted from the patients' medical charts retrospectively. Based on an inquiry of cancer patients in 2010, each item representing the four factors of "total pain" of cancer patients was chosen, i.e., physical distress (pain, changes in appearance), psychological distress (anxiety, depression), social distress (family problems, job-related problems), and spiritual pain; together with sexuality issues, and answers were analyzed. Hospital Anxiety Depression Scale (HADS) was used for the assessment of psychological distress. Chi-square test and Fisher's exact test were performed for gender differences in the cancer distress types. Pearson's analysis and multiple logistic regression analysis were performed for the association of gender with each item.
  
  
  RESULTS
  The data of 101 cancer patients were analyzed and there were more female patients than male patients (female: male ratio = 71:30). Female cancer patients were more likely to suffer from psycho-social issues such as changes in appearance, family problems and sexuality issues than male patients, and male patients were more likely to have spiritual pain.
  
  
  CONCLUSIONS
  There were gender differences in the distress types of cancer patients. In order to improve the quality of whole cancer care, more intensive intervention by medical professionals and social support is needed from the viewpoint of gender-based medicine and psycho-oncology.
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Koyama
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ohtake
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Makimura
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Sakai
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sakamoto
authors.affiliation: Department of Psychosomatic Medicine, Kinki University, Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka 589-8511 Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murata
keywords: Cancer; Distress; Gender differences; Gender-based medicine; Psycho-oncology; Total pain