Cancer Care Hospitals In Japan Research Articles

Establishing quality indicators to comprehensively assess quality assurance and patient safety in radiotherapy and their relationship with an institution’s background

Background and purposeQuality indicators (QIs) for radiotherapy have been proposed by several groups, but no study has been conducted to correlate the implementation of indicators specific to patient safety over the course of the clinical process with an institution’s background. An initial large-scale survey was conducted to understand the implementation status of QIs established for quality assurance and patient safety in radiotherapy and the relationship between implementation status and an institutions’ background. Materials and methodOverall, 68 QIs that were established by this research team after a pilot survey were used to assess structures and processes for quality assurance and patient safety. Data on the implementation of QIs and the institutions’ backgrounds were obtained from designated cancer care hospitals in Japan. ResultsOverall, 284 institutions (72 %) responded and had a median QI achievement rate of 60.8 %. QIs with low implementation rates, such as the implementation of an error reporting system and establishment of a quality assurance department, were identified. The QI achievement rate and scale of the institution were positively correlated, and the achievement rate of all QIs was significantly higher (p < 0.001) in institutions capable of advanced treatments, such as intensity-modulated radiotherapy, and those with a quality assurance department. ConclusionA large-scale survey on QIs revealed their implementation and relationship with a facility’s background. QIs that require improvement were identified, and that these QIs might be effective in providing advanced medical care to many patients.

Chemotherapy effectiveness and age-group analysis of older adult patients with metastatic pancreatic cancer: A Japanese cancer registry cohort study

IntroductionAlthough older adults aged ≥75 years comprise a substantial proportion of patients diagnosed with pancreatic cancer (PC), the effectiveness of chemotherapy in older adults with PC remains to be established. Materials and MethodsThis retrospective study examined the effectiveness of chemotherapy according to age in older adult patients with metastatic PC. We used a large database that combined three data sources (the hospital-based cancer registry database, Osaka Cancer Registry, and Japan's Diagnosis Procedure Combination) and extracted data from patients pathologically diagnosed with metastatic PC between 2013 and 2015 in 31 designated cancer care hospitals in Japan. Propensity score matching (PSM) was used to identify a cohort of patients with similar backgrounds. The effect of chemotherapy on overall survival (OS) was analyzed using the log-rank test. ResultsCompared with 687 younger patients (<75 years old), 276 older adult patients had significant impairments in activities of daily living and poorer prognoses (6.8 vs. 4.1 months, p < 0.001), with a lower frequency of chemotherapy (81.5% vs. 55.1%; p < 0.001). PSM of older adult patients showed that chemotherapy significantly contributed to a better prognosis (best supportive care, 2.6 months vs. chemotherapy, 5.8 months, p < 0.001). Age group analysis with PSM of five-year age ranges revealed that the median OS was significantly longer in the chemotherapy group among older adult patients aged <85 years. DiscussionChemotherapy provides a survival benefit in older adult patients with metastatic PC, and patients aged <85 years could be promising candidates for chemotherapy.

Current status of medical oncology in Japan and changes over the most recent 7-year period: results of a questionnaire sent to designated cancer care hospitals.

BackgroundAccording to a questionnaire sent to Designated Cancer Care Hospitals in Japan in 2013, only 39.4% of the institutes had medical oncology departments. Furthermore, most of these medical oncology departments were primarily responsible for the treatment of limited disease categories and the administration of newly developed therapeutic modalities, including molecular-targeted therapy. The aim of the present study was to update these previous findings and to clarify the changes over the intervening 7-year period.MethodsThe questionnaire was sent to all 393 Designated Cancer Care Hospitals on 13 March 2020. Similar to the previous questionnaires, questions were asked regarding the presence of a medical oncology department, the number of physicians in the department and the degrees of responsibility for drug therapies provided by medical oncologists to adult patients with solid cancers.ResultsIn total, 270 institutions (68.7%) responded. Overall, 145 of these 270 institutions (53.7%) had medical oncology departments, representing a significant increase compared with the results of the previous study (P < 0.01). Among the institutions with a medical oncology department, these departments were responsible for the administration of over 30% of all cytotoxic and molecular-targeted drug therapies for extragonadal germ cell tumors, cancers of unknown primary site, soft tissues, head and neck, esophagus, stomach, colon and rectum, and pancreas as well as the administration of immune checkpoint inhibitors (ICI) for microsatellite instability-high tumors, cancers of the stomach, esophagus and head and neck, and melanoma.ConclusionThe proportion of institutes with medical oncology departments in Japan has increased. In addition, the responsibility of medical oncology departments has expanded to include newly emerging drugs, such as ICIs.

Coverage of the hospital-based cancer registries and the designated cancer care hospitals in Japan.

Hospital-based cancer registries were developed to describe and improve clinical care for cancer patients. We described the hospital-based cancer registry coverage as a reference for the users, including researchers, policymakers and clinicians. The hospital-based cancer registry coverage was defined as the proportion of new cases registered in the hospital-based cancer registry to the National Cancer Registry as the denominator. To examine the coverage of respective cancer types, age groups and prefecture in the hospital-based cancer registry, cases were grouped based on the 10th International Statistical Classification of Diseases and Related Health Problems and were compared with the published report of the National Cancer Registry in 2017. The overall hospital-based cancer registries coverage was 71.7%, and 52.5% of patients were treated at designated cancer care hospitals. The hospital-based cancer registries coverage and treatment rates at designated cancer care hospitals varied per cancer type, age group, and prefecture. The hospital-based cancer registries covered over 80% of the patients with cancers of the larynx, uterus, oesophagus, lip, oral cavity, pharynx and skin, whereas patients' coverage with thyroid cancer was relatively low. The hospital-based cancer registry coverage of young patients (<15years) was >80%, whereas that for elderly patients (≥85years) was <55%. The range of coverage in each prefecture was from 43.0 to 89.7%. Over 70% of the patients with cancers of the larynx, lip, oral cavity and pharynx were treated at designated cancer care hospitals. The hospital-based cancer registry coverage is ~70% of all cancers. Because the coverage differed across cancers and age groups, the respective target groups' analysis should consider this factor.

New Approach for Collecting Cancer Patients' Views and Preferences Through Medical Staff.

PurposeIt is crucial for health professionals to understand patients’ and families’ views and preferences (PVPs) to enhance their adherence to treatments and subsequent satisfaction. Regularly and consistently collecting comprehensive information on the needs and concerns of patients/families and utilizing the information is vital for improving clinical practice and the healthcare environment. As an initial approach, this study aimed to develop a new system for appropriately collecting PVPs regarding cancer from nationwide medical staff and consider the potential utilization of PVPs in clinical practice.MethodsWeb-based anonymous surveys were conducted with medical staff in nationwide cancer care hospitals in Japan. The surveys queried the questions, values, desires, and experiences expressed by cancer patients or their families on five topics, namely two cancer sites (colorectal and esophageal cancers) and three symptoms and signs (lymphedema, urinary symptoms, and tingling/numbness/pain) within the past year. The PVPs were compared to the five topics and staff medical specialties, and those on tingling/numbness/pain were analyzed qualitatively.ResultsAmong the 904 medical staff who responded to this survey, the PVPs encountered by the staff differed according to the topic and staff medical specialty. Tingling/numbness/pain was the most frequently encountered symptom, and urinary symptoms were the least encountered. Only half or fewer of the medical staff had information available regarding urinary symptoms and tingling/numbness/pain. Further, qualitative content analysis of the expressed PVPs regarding tingling/numbness/pain raised clinical questions on this topic that led to the construction of a “Questions & Answers” section on a public website in Japan.ConclusionThis study suggests that collecting PVPs through nationwide cancer-related medical staff might be an efficient way to understand the specific requirements of patients/families. It would also be possible to document PVP trends according to changes in the environments of patients/families by nationwide, consistent, and continuous PVP collection.

Actual Situations and Factors Related to Nursing Activities in Supporting the Transition to Homecare Settings for End-Stage Cancer Patients in General Wards in Japan.

This study aimed to investigate actual situations of nursing activities in supporting the transition to homecare settings for end-stage cancer patients and to determine factors related to executing such nursing activities from the perspectives of communication skills and interprofessional collaboration. A cross-sectional study was conducted with 513 nurses who worked at designated cancer care hospitals in Japan. A total of 318 valid responses were obtained (valid response rate: 62.0%). Scores for nursing activities were higher for the following items: sharing information regarding the transition to homecare settings, intentionally engaging with patients after their medical conditions were explained, providing care for families, and understanding a patient's will about the transition to homecare settings. On the other hand, scores were lower for items that were related to guiding juniors and self-improvement. A multiple regression analysis was performed with nursing activities as the dependent variable. 8 factors related to nursing activities were determined: experience in supporting the transition to homecare settings as a primary nurse, contribution to a team (Team Approach Assessment Scale [TAAS]), years of nursing experience, function of a team (TAAS), regulation of interpersonal relationship (ENDCOREs communication skills scale), experience of participation in homecare nursing education or seminars, verbal communication skills for good communication (End-of-life Care Nurses' Communication Skills scale), and educational background. Future challenges include developing an educational program based on the results of the present study and promoting educational intervention studies.

Validation of an assessment tool: Estimation of Postoperative Overall Survival for Gastric Cancer

BackgroundBenchmarking of long-term surgical outcomes has rarely been attempted. We previously devised a prediction model for assessing the outcome of late survival after surgery, termed the Estimation of Postoperative Overall Survival for Gastric Cancer (EPOS-GC). This study was undertaken to validate EPOS-GC in an external data set. MethodsA retrospective cohort study was conducted in 11 cancer care hospitals in Japan, analyzing a consecutive series of patients who underwent elective gastric cancer resection between April 2007 and March 2009. EPOS-GC consists of three tumor-related variables and three physiological variables. The primary endpoint was postoperative overall survival. The observed-to-expected (O/E) ratio of 5-year survival rates was defined as a metric of quality of care. The sample size for O/E was determined as 42. ResultsWe included 2045 patients for analysis. The median (95% confidence interval) follow-up time was 5.1 (1.2–6.8) years for censored patients. Although EPOS-GC demonstrated a good discriminative power (Harrell's C-index, 95% confidence interval: 0.80, 0.79–0.83), the calibration plot revealed that EPOS-GC underestimated 5-year survival rates in the high-risk group. Therefore, we recalibrated the model with Cox's regression analysis. The recalibrated EPOS-GC showed a good calibration, preserving the high discriminative power (C-index, 95% confidence interval: 0.80, 0.78–0.82). The O/E among hospitals according to the recalibrated EPOS-GC ranged between 0.87 and 1.27. The O/E correlated with hospital volumes (Spearman's correlation = 0.76, n = 11, p = .006). ConclusionEPOS-GC with recalibration can convey risk-adjusted quality assurance regarding late survival following gastric cancer resection.

The use of neoadjuvant therapy for resectable locally advanced thoracic esophageal squamous cell carcinoma in an analysis of 5016 patients from 305 designated cancer care hospitals in Japan.

Recent studies have shown the benefits of neoadjuvant therapy with chemotherapy or chemoradiotherapy for resectable locally advanced thoracic esophageal squamous cell carcinoma (ESCC). The aim of our study was to elucidate the use of neoadjuvant therapy for thoracic ESCC in Japan. Data on patients with stage IB-III thoracic ESCC were retrieved from the national database of hospital-based cancer registries combined with claims data between 2012 and 2013. These data were analyzed using a mixed-effect logistic regression analysis, with a focus on exploring patterns in the first-line treatment for ESCC, including proportion of patients who received neoadjuvant therapy, and investigating the hospital characteristics and patient factors associated with the use of neoadjuvant therapy. Of the 5016 patients with stage IB-III thoracic ESCC at the 305 participating hospitals, 34.2% received neoadjuvant therapy (neoadjuvant chemotherapy, 29.5%; neoadjuvant chemoradiotherapy, 4.7%). The therapy was less likely to be administered to older patients (≤64years, 48.8%; 65-70years, 42.0%; 70-75years, 33.9%; 75-80years, 22.2%; 80-85years, 3.8%; ≥85years, 1.4%) and at hospitals with a low volume of patients (very high, 42.1%; high, 37.5%; low, 30.7%; and very low, 26.4%). This trend was confirmed by regression analysis. Based on our results, in Japan, relatively few patients with resectable locally advanced thoracic ESCC receive neoadjuvant therapy, with older patients and patients at lower volume hospitals being less likely than other patients to receive the neoadjuvant therapy. We recommend that the process of treatment decision-making be assessed at both the patient and hospital levels so that patients can consider various treatment options, including neoadjuvant therapy with surgery in Japan.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan.

We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. We received 374 responses (11,693 procedures) from 153 centers (38.5%). The overall complication rates were 7.4% for the chest (598/8,097 cases); 6.8% for the neck (157/2325); 5.2% for the upper arm (54/1,033); 7.3% for the forearm (9/124); and 6.1% for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P=0.010), and multivariate logistic regression (odds ratio 0.69; 95% confidence interval 0.51-0.91; P=0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8%), followed by the neck (69.8%), forearm (53.2%), chest (41.8%), and other groups (34.2%). Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.

Patterns of prescribing radiotherapy and bevacizumab in nationwide practice - analysis of 101 designated cancer care hospitals in Japan.

Radiotherapy and bevacizumab are each effective in treating patients with advanced cancer, but their concurrent use may cause serious adverse events (SAEs). Whereas sequential administration can theoretically reduce the risk of SAEs while maintaining the anticancer effects, this hypothesis remains unconfirmed, leading to variations in practice. To elucidate current practices, the patterns of care received by patients in Japan with regard to these two therapies were assessed in a large database of a hospital-based cancer registry linked with insurance claims. This database contained information on 106 057 patients diagnosed with seven major cancers in 2011 and the care they received up to the end of 2012. In total, 335 patients from 101 hospitals in the database were treated with both radiotherapy and bevacizumab. Of these patients, 50.8% had lung cancer, and 51.3% had Stage IV cancer. Of the 335 patients, 75 (22.4%) received these therapies concurrently. In patients treated sequentially, the time from the last dose of bevacizumab to the start of radiotherapy was most frequently 4–5 weeks (12.4%), whereas the time from the end of radiotherapy to the start of bevacizumab was most frequently 1–2 weeks (10.6%). The cumulative proportions of patients in these two groups receiving sequential therapies within 3 weeks were 19.0% and 26.1%, respectively. Many practices appeared to avoid the concurrent use of bevacizumab and radiation, but some provided concurrent therapy. Additional data are required to determine whether the avoidance of concurrent use should become a standard of care.

Establishing a system to monitor and evaluate the quality of cancer care in Japan.

287 Background: To ensure equitable access to high-quality cancer care, efforts to routinely measure key performance indicators of cancer policy began in Japan in 2014. Although assessing the quality of cancer care is a vital component of this initiative, a system for evaluating process of care across a large number of hospitals has not yet been established. We aimed to establish this system by creating a database of health claims data linked to hospital-based cancer registry (HBCR) and measuring quality indicators (QIs) for cancer care. Methods: We created a database of 28 months (Sept10-Dec12) of health claims data linked to HBCR for 100,825 breast, prostate, colorectal, stomach, lung, liver, and cervical cancer patients who were newly diagnosed in 2011 from 178 designated cancer care hospitals in Japan. Among 206 QIs that were previously developed by a panel of experts, we measured 13 that were measureable from claims data: 1) seven QIs on adherence to guidelines on adjuvant therapy, 2) four QIs on lab tests, procedures, and medication, and 3) two QIs on supportive care. Results: QIs investigating adherence to clinical guidelines on adjuvant therapy tended to be lower compared to QIs for supportive care. For example, 48.0% [46.4, 49.6] of stage III colorectal cancer patients (n=3,638) received adjuvant chemotherapy (5FU+LV, UFT+LV, Cape, FOLFOX, or CapeOX) within 8 postoperative weeks, whereas 68.1% [67.2, 69.0] of patients (n=10,104) received three-drug combination (5HT3-r antagonist, dexamethasone, and aprepitant) before receiving highly emetogenic chemotherapy. QIs on appropriate testing and procedures were higher overall, such that 83.3% [82.6, 84.0] of invasive breast cancer patients (n=12,447) received HER2 testing. In all QIs, there was large variability in performance across hospitals. Feedback was given to hospitals through interactive webpages. Conclusions: This is the first attempt at measuring the quality of cancer care across such a large number of hospitals in Japan. Our research showed that in all QIs, there was ample room for improvement. Continuous monitoring, improving feedback methods, expansion of QIs, and application of electronic health records, will be our next challenge as we move forward in this initiative.

Survey of Advanced Radiation Technologies Used at Designated Cancer Care Hospitals in Japan

Our survey assessed the use of advanced radiotherapy technologies at the designated cancer care hospitals in Japan, and we identified several issues to be addressed. We collected the data of 397 designated cancer care hospitals, including information on staffing in the department of radiation oncology (e.g. radiation oncologists, medical physicists and radiation therapists), the number of linear accelerators and the implementation of advanced radiotherapy technologies from the Center for Cancer Control and Information Services of the National Cancer Center, Japan. Only 53% prefectural designated cancer care hospitals and 16% regional designated cancer care hospitals have implemented intensity-modulated radiotherapy for head and neck cancers, and 62% prefectural designated cancer care hospitals and 23% regional designated cancer care hospitals use intensity-modulated radiotherapy for prostate cancer. Seventy-four percent prefectural designated cancer care hospitals and 40% regional designated cancer care hospitals employ stereotactic body radiotherapy for lung cancer. Our multivariate analysis of prefectural designated cancer care hospitals which satisfy the institute's qualifications for advanced technologies revealed the number of radiation oncologists (P = 0.01) and that of radiation therapists (P = 0.003) were significantly correlated with the implementation of intensity-modulated radiotherapy for prostate cancer, and the number of radiation oncologists (P = 0.02) was correlated with the implementation of stereotactic body radiotherapy. There was a trend to correlate the number of medical physicists with the implementation of stereotactic body radiotherapy (P = 0.07). Only 175 (51%) regional designated cancer care hospitals satisfy the institute's qualification of stereotactic body radiotherapy and 76 (22%) satisfy that of intensity-modulated radiotherapy. Seventeen percent prefectural designated cancer care hospitals and 13% regional designated cancer care hospitals had a quality assurance committee. The numbers of radiation oncologists and other operating staff might be essential factors in the implementation of advanced radiotherapy technologies. Small proportions of regional designated cancer care hospitals satisfy the institute's qualifications of advanced technologies.

Quality of gastric cancer care in designated cancer care hospitals in Japan

To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. A retrospective medical record review. Eighteen designated cancer care hospitals throughout Japan. A total of 1685 patients diagnosed with gastric cancer in 2007. Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

Japanese structure survey of radiation oncology in 2009 with special reference to designated cancer care hospitals

The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. Designated cancer care hospitals accounted for 50.0% of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3%; three-dimensional conformal radiotherapy function: 88.5 and 70.0%; intensity-modulated radiotherapy function: 51.6 and 25.3%; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2%; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

1177P - Variations of Discordance of the Clinical TNM Stage with the Pathological TNM Stage between Japanese Designated Cancer Hospitals

ABSTRACT Introduction Previous studies showed that TNM stages that were clinically determined before surgery were not often concordant with pathological TNM stages. However, no previous studies have examined variations of discordance of the clinical TNM stage with the pathological TNM stage among hospitals. We aimed to examine the discordance of the clinical and pathological stages among Japanese designated cancer hospitals using compiled data from the hospital-based cancer registry submitted from 286 designated cancer care hospitals in Japan. Methods The registry data had UICC TNM stages before and after surgery for stomach, colorectal, lung and breast cancer patients treated in these hospitals. We excluded patients who received adjuvant chemotherapy or radiotherapy, patients who received care from facilities with less than 10 patients, male breast cancer and patients whose stages were unknown from the analysis. We also calculated discordance of stages that could have theoretically resulted in changes in surgical procedures or treatment choice. Discordance was also calculated after excluding stage IV patients as sensitivity analysis. Results In total, 145,726 patients (38,692 stomach, 47,304 colorectal, 19,643 lung and 40,096 breast cancer patients) were included in the analysis. Patients' mean age and clinical TNM stage varied across hospitals. The facility-level discordance between clinical and pathological stages ranged from 4% to 52% in stomach cancer, 3% to 57% in colorectal cancer, 0% to 50% in lung cancer and 1% to 45% in breast cancer. TNM stages before surgery were lower than after surgery in more than half of the cases. The multi-level logistic regression model showed that variance in facilities existed after adjustment for age, sex and clinical TNM stage. Discordance of stages that could lead to changes in the surgical procedures or treatment choice ranged from 4% to 58% in stomach cancer, 4% to 63% in colorectal cancer, 0% to 5% in lung cancer, and 5% to 52% in breast cancer. Sensitivity analysis yielded similar results. Conclusion We can confirm variations of discordance of TNM stages before and after surgery. Disclosure All authors have declared no conflicts of interest.

Japanese Structure Survey of Radiation Oncology in 2007 with Special Reference to Designated Cancer Care Hospitals

The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure was also examined. The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007. The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared. Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following: linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals was associated with population size. The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology medical care system in Japan.

National structure of radiation oncology in Japan with special reference to designated cancer care hospitals

The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities. The Japanese Society of Therapeutic Radiology and Oncology (JASTRO) conducted a questionnaire survey about the national structure of radiation oncology in 2005. In the current study, the structures of 326 designated cancer care hospitals and the other 386 radiotherapy facilities in Japan were compared. Designated cancer care hospitals accounted for 45.3% of all radiotherapy facilities. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were as follows: linear accelerators/facility, 1.2 and 1.0; dual-energy function, 73.1% and 56.3%; three-dimensional conformal radiotherapy function, 67.5% and 52.7%; intensity-modulated radiotherapy function, 30.0% and 13.9%; annual number of patients/linear accelerator, 289.7 and 175.1; (192)Ir remote-controlled afterloading systems, 27.6% and 8.6%; and average number of full-time equivalent radiation oncologists/facility, 1.4 and 0.9 (P < 0.0001). There were significant differences in equipment and personnel between the two types of facilities. Annual patient loads/full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 252 and 240. Geographically, the number of designated cancer care hospitals was associated with the population, and the number of JASTRO-certified physicians was associated with the number of patients undergoing radiotherapy. The Japanese structure of radiation oncology in designated cancer care hospitals was more mature than that in the other radiotherapy facilities in terms of equipment, although a shortage of personnel still exists. The serious understaffing problem in radiation oncology should be corrected in the future.