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Current status of integrating oncology and palliative care in Japan: a nationwide survey

  • Uneno, Y.1, 2
  • Sato, K.3
  • Morita, T.4
  • Nishimura, M.5, 6
  • Ito, S.6
  • Mori, M.7
  • Shimizu, C.8
  • Horie, Y.9
  • Hirakawa, M.9
  • Nakajima, T. E.9
  • Tsuneto, S.10
  • Muto, M.1
  • 1 Kyoto University, 54 Kawaharacho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan , Kyoto (Japan)
  • 2 Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan , Hamamatsu (Japan)
  • 3 Nagoya University Graduate School of Medicine, Nagoya, Japan , Nagoya (Japan)
  • 4 Seirei Mikatahara General Hospital, Hamamatsu, Japan , Hamamatsu (Japan)
  • 5 Geriatric Health Service Facility, You-You no Sono, Hiroshima, Japan , Hiroshima (Japan)
  • 6 Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan , Kyoto (Japan)
  • 7 Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan , Hamamatsu (Japan)
  • 8 National Center for Global Health and Medicine, Tokyo, Japan , Tokyo (Japan)
  • 9 St Marianna University School of Medicine, Kawasaki, Japan , Kawasaki (Japan)
  • 10 Kyoto University, Kyoto, Japan , Kyoto (Japan)
Published Article
BMC Palliative Care
BioMed Central
Publication Date
Jan 24, 2020
DOI: 10.1186/s12904-020-0515-5
Springer Nature


BackgroundPalliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians’ perception of IOP.MethodsThe questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared.ResultsIn total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and < 30% were planning to increase the staff members.ConclusionsThis survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further efforts are needed to address the serious research/educational gaps.

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