A pilot survey on the outpatient chemotherapy unit of national university hospitals in Japan for early palliative care

Abstract

Abstract Background Over the past decade, multiple randomized controlled trials have demonstrated that involvement of palliative care services concurrent with chemotherapy (Cx) can improve health outcomes including overall survival. It is widely accepted that not only inpatients, but also outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with Cx. However, it is not established how to integrate early palliative care into standard oncology care. Since 2002, Outpatient Chemotherapy Unit, which is the room for cancer outpatients to receive Cx, has been established in hospitals under National health insurance in Japan. Methods To build an early palliative care delivery system for outpatients with cancer, we conducted a pilot survey on the management status of the outpatient chemotherapy unit from 2007 to 2017. The data was extracted from the Database Center of National University Hospitals in Japan ( http://plaza.umin.ac.jp/dbcenter/index.html ). Results There were 42 outpatient chemotherapy units of national university hospitals in Japan (The median of beds in each unit was 21 (range: 8-65)). The number of outpatient Cx conducted in the units has been increasing continuously year by year since 2002, which has been 2.6 times in the last decades (the median: from 2400/yr in 2007 to 6200/yr in 2017). Focusing on the 18 small scale university hospitals as ours (the total number of beds in each hospital equals to around 600 beds), it has been tripled from 1600/yr in 2007 to 4800/yr in 2017. Conclusions This survey revealed that the rapid growing number of cancer patients have been receiving Cx in outpatient settings in the last decade in Japan. Because the routine work burden has also been increasing, proper staffing and human resource development are considered urgent issues. It is necessary to consider the new model to promote integration of oncology and early palliative care for outpatients in Japan.