Abstract
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.
Highlights
Palliative 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
150 non-Government-designated cancer hospital (DCH) (31.4%) were included for analyses where surgery, chemotherapy, and radiation therapy were performed within the same hospitals to ensure comparability
Routine symptom screening was performed in more than half of the DCHs (65.1% vs. 34.7%); routine documentation of advanced care planning was performed in < 40% in both types of hospitals (39.0% vs. 28.7%)
Summary
Palliative 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. The Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; its detailed progress remains unclear. This cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians’ perception of IOP. Several academic societies, including the European Society for Medical Oncology and American Society of Clinical Oncology, strongly support and recommend integrating oncology and palliative care (IOP) in daily oncology practice [6, 7].
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