Care Cancer Hospital Research Articles

Disparities in Patient Navigation Resources in Appalachia

Background: The study was conducted in support of an R01-funded project, “Patterns of Patient Care in Appalachia”. Most counties within Appalachia are designated as medically underserved, have sparse health care resources and lack integrated care systems. This study determined the extent of geographical differences among American Cancer Society (ACS) patient navigation resources (navigator and/or cancer resource center) in Appalachia. Specifically, this study investigated if there were barriers to access to ACS patient navigation for cancer care in the Appalachia region of PA, KY, OH, and NC. Results: Of the cancer care centers and hospitals in the Appalachia region studied, (n=232), web-based data informed that facilities (n=186, 80.0%) did not have ACS patient navigation resources compared to Appalachia cancer care centers and hospitals with ACS PN services = 20%. KY had fewer ACS PN centers (5) compared to PA (20), with Pittsburgh (Allegheny county) containing a noticeable cluster of ACS PN facilities (N = 6 out of 18 total). KY also had the lowest rates (12.5%) of facilities with ACS patient navigators. North Carolina had the highest rate of facilities with ACS patient navigation services compared to OH, KY, and PA (32.2%). The proportion of facilities with ACS PN were proportionately less for facilities located in non-Metropolitan areas (15%) compared to those located in metropolitan areas (26%, chi-square p = 0.0339). Significance: Two overarching results were identified in this study. Firstly, a large number of cancer care centers in the Appalachian region do not have ACS patient navigator services which enable patients to gain individualized assistance, overcome barriers that hinder access to care and access to information about the illness and services available. Secondly, the lack of standards and curriculum for patient navigators indicates there is considerable variation in level of exposure for each patient navigator.

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs.

地域がん診療連携拠点病院における緩和ケア外来でのがん患者と家族に対する意思決定支援

地域がん診療連携拠点病院における緩和ケア外来でのがん患者と家族に対する意思決定支援

がん患者の疼痛の実態と課題―外来／入院の比較と高齢者に焦点をあてて―

【背景】高齢がん患者の疼痛の実態は十分に明らかとなっていないことが多い．ケアの質向上のためにも，こうした実態を含めた課題の把握が必要である．【目的】がん患者の疼痛と対処状況の特徴，および，課題を把握する．【方法】都道府県がん診療連携拠点病院である青森県立中央病院の全がん患者で同意が得られた者を対象に疼痛の状況やQOL，治療歴等を収集し，入院／外来，および，高齢者（≧65歳）／非高齢者（＜65歳）を比較した．【結果】回答率は57.0％であり，入院より外来で疼痛患者のうち除痛不十分な頻度は高く（除痛率：外来28.9％ vs入院：52.6％，NRS：外来3.9 vs入院2.1，P＜0.001），外来で特に高齢者の除痛率が低かった（高齢者： 24.7％ vs非高齢者： 35.8％，P＜0.01）．【結論】一般に外来での疼痛の評価・介入の工夫が必要であると考えられるが，特に高齢者への介入の優先度が高いことがうかがえた．

Assessing the validity of using claims data compared to medical chart reviews for measuring care quality in Japan.

264 Background: Health insurance claims data have been used extensively as a less labor-intensive method of collecting data than medical record reviews, which are the preferred source of data collection in most medical studies. Although recent reports have raised questions about its validity of use in measuring care quality, validity of using claims data may differ by health systems and should therefore be assessed by country. We aimed to test the validity of using claims data in Japan by comparing quality performance scores obtained from claims data to those derived from medical record reviews. Methods: We reviewed medical records from Apr 2013 to Apr 2014 of gastric and colorectal cancer patients who were diagnosed in 2011 from 4 cancer care hospitals in Okinawa. We calculated the proportion of patients who received adjuvant chemotherapy for gastric and colorectal cancer using claims data, and compared the results with those obtained from medical record reviews. Chart reviews were performed by certified tumor registrars. We used kappa coefficients to measure the level of agreement between claims data and medical record reviews. Results: Analysis using claims data resulted in 14 Stage II and III gastric cancer patients who had undergone surgery, with 50% receiving adjuvant chemotherapy; whereas medical record reviews resulted in 19 patients, 94.7% of whom either received or had a clinically valid rationale for not undergoing adjuvant therapy. For colorectal patients, claims data resulted in 48.5% of 68 surgical stage III colorectal patients receiving adjuvant therapy, compared to 74.4% of 78 patients using medical record reviews who either received adjuvant therapy or had a valid reason for not undergoing therapy. Agreement between claims data and chart reviews was low (kappa=0.14) for gastric cancer, but fair (kappa =0.37) for colorectal cancer. Conclusions: Our analysis showed that use of claims data may greatly underestimate quality performance measures if they are not compensated by medical record reviews. Claims data alone cannot capture a large proportion of patients who either choose not to, or has a clinically valid reason for not undergoing standard 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.

Persistent Dysphagia after Head and Neck Radiotherapy: A Common and Under-reported Complication with Significant Effect on Non-cancer-related Mortality

AimsDysphagia is a well-recognised acute complication after radiotherapy. However, knowledge about the long-term prevalence and effect remains limited. The aims of this study were to determine the prevalence, severity, morbidity, time course and reporting patterns of dysphagia symptoms after head and neck radiotherapy. Materials and methodsAn observational cross-sectional study was conducted in a large consecutive series of head and neck cancer patients. All patients in the St George Hospital Cancer Care database who had received head and neck radiotherapy with curative intent 0.5–8 years previously and recorded as being alive were surveyed using the Sydney Swallow Questionnaire (SSQ). Case notes were reviewed to determine the level of awareness of swallowing dysfunction in all patients, as well as the causes of mortality in the 83 deceased patients. ResultsThe mean follow-up at the time of survey was 3 years after radiotherapy (range 0.5–8 years). Of the 116 patients surveyed by questionnaire, the response rate was 72% (83). Impaired swallowing (SSQ score > 234) was reported by 59% of patients. Dysphagia severity was not predicted by tumour site or stage, nor by the time since therapy, age, gender or adjuvant chemotherapy. Review of the hospital medical records and cancer database revealed that cancer accounted for 55% of deaths and aspiration pneumonia was responsible for 19% of non-cancer-related deaths. Of those with abnormal SSQ scores, only 47% reported dysphagia during follow-up clinic visits. ConclusionsPersistent dysphagia is a prevalent, under-recognised and under-reported long-term complication of head and neck radiotherapy which currently cannot be predicted on the basis of patient, tumour or treatment characteristics. Aspiration pneumonia is an important contributor to non-cancer-related mortality in these patients. These data highlight the need for closer monitoring of swallow dysfunction and its sequelae in this population.

Current status of medical oncology in Japan--reality gleaned from a questionnaire sent to designated cancer care hospitals.

Medical oncology in Japan has a relatively short history, with specialist certification starting in 2006, resulting in 867 certified medical oncologists as of 2014. Although the national government has appointed 397 Designated Cancer Care Hospitals, little is known about the actual situations of medical oncology services at these institutions. Questionnaires regarding the presence of a medical oncology department, the number of physicians in the department, the presence of certified medical oncologists and the degree of the medical oncologists' responsibilities for drug therapies in adults with solid cancers were sent to all 397 institutions between 21 January and 1 May 2013. The response rate was 68.0%. Among the responses, 39.4% of the institutions had medical oncology departments with a median of three physicians. Most of the medical oncology departments were primarily responsible, as evaluated according to patient number, for the treatment of limited disease categories. The medical oncologists were significantly more responsible for molecular-targeted therapy than for chemotherapy in head and neck cancer or for cytokine therapy in renal cell carcinoma. The wide variety of adverse events associated with molecular-targeted therapy might have enhanced the roles of medical oncologists. As the proportion of hospitals with a medical oncology department increased according to the number of certified medical oncologists working at the institution, cultivating medical oncologists seems to be an urgent task for advancing medical oncology in Japan. The present study provides fundamental data for the future development of medical oncology in Japan. The present study is to uncover the current situation of medical oncology in Japan.

The Role of a Psychiatrist (Rehabilitation Physician) in the Palliative Care Team

Objective: Although palliative care consultation teams (PCTs) have become an integral part of all regional cancer care hospitals, cancer rehabilitation is still in the developing stage in Japan. At our hospital, a physiatrist, or a rehabilitation physician, joined the PCT as a member, and we have been achieving good results. The purpose of this study is to clarify the role of a physiatrist as a member of the PCT by investigating the current status of the PCT at our hospital.Method: We retrospectively analyzed the records of 144 patients receiving rehabilitation out of 345 patients who had started receiving PCT services from April 2012 to March 2013 at Keio University Hospital.Results: Among the 144 patients, 67 patients (46.5%) had already received rehabilitation before starting PCT services, and the remaining 77 patients (53.5%) started receiving rehabilitation based on the recommendation by the physiatrist. In the later group, Dietz Cancer Stage Classifications were: preventative, 6.5%; restorative, 40.0%; supportive, 45.5%; and palliative, 9.1%. ECOG-PS were: PS0, 0.0%; PS1, 23.4%; PS2, 29.9%; PS3, 28.6%; and PS4, 18.2%. The main purposes of rehabilitation were: 1) fracture prevention and pain relief of limbs with bone lesions, 2) social support (e.g. measures for the reduction of nursing requirement, assistance in finding social aids, counseling for family members), 3) psychological support, 4) treatment of lymphedema, 5) management of breathlessness, 6) and approaches to swallowing deficits.Conclusions: Half of the cancer patients started rehabilitation after the intervention by the PCT. Many patients receiving PCT services also needed rehabilitation services and the physiatrist had an important role of evaluating the rehabilitation needs. Physiatrists can act as important members of PCTs to maximize QOL while addressing the physical, psychological, social and spiritual needs of both patients and their families.

Progressive Development and Enhancement of Palliative Care Services in Japan: Nationwide Surveys of Designated Cancer Care Hospitals for Three Consecutive Years

ContextPolicymaking plays an important role in national palliative care services. The Japanese Cancer Control Act was implemented in 2006. ObjectivesTo evaluate changes in the structure and processes of palliative care services after implementation of the Cancer Control Act. MethodsWe conducted annual nationwide surveys in designated cancer care hospitals (DCCHs, n = 349) between 2008 and 2010. The 65-item questionnaire was divided into seven domains: institutional framework, information to patient and family, practice of palliative care, activities of the palliative care teams (PCTs), members of PCTs, regional medical cooperation, and education. Increasing trends were tested using generalized estimating equation models. ResultsThe response rates were ≥99%. All domains showed an increasing trend (P < 0.001). There were significant increases in full-time PCT physicians (27.4%–45.7%, Ptrend < 0.001), full-time PCT nurses (38.9%–88.0%, Ptrend < 0.001), and the median number of annual referrals to PCTs (60–80 patients, P < 0.001). Essential drugs were available in most DCCHs from baseline. Although outpatient clinics increased significantly (27.0%–58.9%, Ptrend < 0.001), community outreach programs did not (9.0%–12.6%, P = 0.05). Basic education was actively introduced for in-hospital physicians and nurses (78.2% and 91.4% in 2010), but often unavailable for regional health care providers (basic education for regional physicians and nurses: 63.9% and 71.1% in 2010). ConclusionThe Cancer Control Act promoted the development and enhancement of palliative care services in DCCHs. Regional medical cooperation and education are the future challenges of palliative care in Japan.

Comparison of Yoga vs. Relaxation on Chemotherapy Induced Nausea and Vomiting Outcomes: A Randomized Controlled Trial

Objective: Nausea and emesis are two major side effects and known to be partly psychological rather than purely pharmacological in nature. Yoga as a complimentary modality is extensively known to reduce anxiety, physiological arousal and stress associated with chemotherapy. This study will compare the effect of Yoga with Jacobson's relaxation to understand the underlying neural mechanisms like gastric motility changes (Electrogastrogram) and sympathovagal changes on HRV spectral analysis that accompany chemotherapy induced nausea and emesis and evaluate the influence of intervention on these mechanisms. Method/Design: This is a randomized controlled 3 arm clinical Trial. 120 chemo naive subjects will be randomized into three groups, with 42 subjects for Yoga, 42 for Jacobson's group and 36 in control group. Setting: This study will be conducted at Comprehensive cancer care hospital. Participants: 200 patients will be screened and 150 subjects who satisfy the selection criteria (those with gynecological malignancies, between 18-70 years, with basic education and those who have never been exposed to chemotherapy before and who give their consent to participate and give consent to participate) will be taken into the study. Primary outcome measure: The Functional Living Index-Emesis (FLIE), emesis-and nausea-specific Qol questionnaire is administered with a 24 hour recall followed by a 4-day recall for studying acute and delayed chemotherapy-induced emesis. Secondary outcome measure: Include psychological measures such anxiety, depression and perceived stress that influence chemotherapy induced nausea and emesis. It also includes cardiac autonomic function and surface electrogastrogram to assess the neurophysiological correlates of yoga in modulating nausea and emesis. Intervention: The yoga intervention consists of asanas (postures), breathing exercises, and relaxation techniques for 25 minutes. The progressive muscle relaxation involves tightening each and every muscle of the body and then relaxing the same one by one for 25 minutes. Conclusion: This study will help us understand the mechanism of action of yoga intervention in controlling chemotherapy induced nausea and vomiting.

Point prevalence survey of antimicrobial utilization in oncology patients

Point prevalence surveys have been used internationally to characterize the use of antimicrobial agents. The primary objective of this study was to determine prevalence of antimicrobial use in the oncology population in Qatar. Data was collected from the National Center for Cancer Care and Research hospital over 3 separate days during a two week period. Adults admitted on the day of audit were included. Prevalence of antimicrobial use during the audit was 43% (25/58). The most commonly prescribed class of antimicrobial agents was penicillin/Beta-lactamase inhibitor combinations 39.4% (13/33). Findings demonstrate frequent antimicrobial consumption of broad spectrum antimicrobial agents which highlights the importance of expanding antimicrobial stewardship programs in this population.

Abstract P4-06-10: Breast cancer subtypes in Indian women: A comparison of clinicopathological features and outcome

Abstract Background: Immunohistochemical markers are often used to classify breast cancer into different subtypes that have distinct biological behaviour. The aim of this study was to estimate the distribution of the different subtypes of breast cancer based on immunohistochemistry, in the Indian population and determine their associations with clinicopathological features and outcome. Methods: This is a 5 year retrospective study of 521 breast cancer patients to compare the clinicopathological features and survival of four subgroups – Luminal A (ER/PR +, Her 2 neu –), Luminal B (ER/PR +,Her 2 neu +), Her 2 enriched (ER-/PR -, Her 2 neu +)and triple negative(ER-,PR-,Her 2 neu -). Results: Majority (43.8%) of the patients were in luminal A subgroup. Luminal B patients were 14.8%, Her 2 enriched group were 16.1% and triple negative patients were 25.3%. Median follow up was 34 months. Patients in luminal A subgroup were more likely to be postmenopausal, have smaller size tumours, have grade I/II tumours and have better survival (OS-91.06%), though it was not statistically significantly different from other subgroups. Clinicopathological characteristics and outcome according to breast cancer subtypes Luminal ALuminal BTriple negativeHer 2 neup valueMenopausal statusPre39.09%13.71%30.46%16.75% Post46.60%15.43%22.22%15.74%0.159Type of surgeryBCS44.25%19.54%22.99%13.22% MRM41.78%12.50%27.96%17.76%0.099Type of chemotherapyAnthra based36.68%11.32%29.25%20.75% Taxane + Anthra based36.97%14.29%29.41%19.33%0.923Tumor size in cmsLess than 254.55%12.12%21.21%12.12% 2-546.52%13.52%27.27%12.83% &amp;gt; 528.57%9.52%33.33%28.57%0.065OutcomeAlive without disease44.41%15.59%24.75%15.25% Alive with disease42.67%16.0%25.33%16.0% Death35.56%15.56%26.67%22.22%0.924Grade of tumorI71.43%17.86%3.57%7.14% II51.19%11.95%22.87%13.99% III23.21%16.96%39.29%20.54%&amp;lt;0.001table 1 The triple negative subgroup was more likely to be premenopausal (p value 0.036, odds ratio 0.611, CI 0.394-0.949), have larger and grade III tumours and had worse overall survival (OS-88.46%, odds ratio 1.32, 95%CI 0.602-2.39). Patients in Her 2 enriched group also had the bad prognostic features like larger tumour size, higher grade and worst survival (OS-85.07%, odds ratio 1.78, 95% CI 0.767-4.163).However the outcome was not statistically significantly different for all the subgroups. Conclusions: In this tertiary cancer care hospital retrospective study of breast cancer patients in India, according to the luminal subtypes, luminal A had better prognostic features and survival compared to other subgroups.Incidence of triple negative patients was high, who were mainly premenopausal.Her 2 enriched group had the worst survival among all. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-06-10.

Inexpensive solutions to enhance remote cancer care in community hospitals

Rapidly increasing volume and complexity of information used for multidisciplinary cancer treatment requires carefully evolving communications with programmatic planning, detailed evaluation, and new methodologies and technical approaches to enhance the impact and efficacy of medical conferencing systems. We designed, implemented, and evaluated cost-effective and appropriate remote learning optimize oncology practice techniques in community hospitals. Our experience over the course of more than 7 years demonstrated simple and inexpensive communication solutions for both professional and lay education, satisfying information-dense needs of multimodality cancer care. We describe how potential complexities may be resolved with inexpensive devices and software programs. Staff teamwork and creativity are always required to implement constantly evolving technologies. We provide both quantitative and qualitative data describing activities and resulting staff responses resulting in 6,520 personnel with more than 391 aggregate credit hours of continuing medical education and continuing education credit activities with enhanced collegial participant satisfaction levels and heightened interactions/professionalism among regional oncology staff. We noted significant cost reductions for communications in all our three partnered hospitals. We demonstrated both increased satisfaction levels and heightened levels of behavioral changes (Impacts) in participants. Always, activities must be cost effective and responsive to changing medical needs. Community focused efforts with regional partners should be similar, assuring evolving successes.

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.

The National Database of Hospital-based Cancer Registries: A Nationwide Infrastructure to Support Evidence-based Cancer Care and Cancer Control Policy in Japan

Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.

Tobacco related cancers at a tertiary care hospital in Western India

Background: Tobacco related cancers represent the most preventable form of cancer in our society. Objective: To determine the proportion of tobacco related cancers among male and female cancer patients at a tertiary cancer care hospital in Western India. Methods: This is a retrospective patient record based retrieval type of study which was conducted at a leading tertiary cancer care hospital of Western India. Analysis of case records of all cancer patients admitted at the Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Maharashtra, (India) over a 24-month period was done. The case records of total three thousand five hundred and two (3502) cancer patients were retreived and analysed to know the proportion of tobacco related cancers. Data obtained ware analysed using SPSS version 16.0 and presented in the form of percentages and proportions. Chi square test of significance was used.Results: The total proportions of tobacco related cancers (TRCs) among male and female subjects combined togethe was 22.8%. The proportion of TRCs in male was 33.1%, while in female it was 12.5%. Oral cancers and oesophageal cancers were the leading sites among the TRCs in male and female respectively. Conclusion: One third of all cancers in men occurred in the sites associated with tobacco use (TRCs). In women, one eighth of cancers occurred at these sites. Health Renaissance, January-April 2013; Vol. 11 No.1; 43-46 DOI: http://dx.doi.org/10.3126/hren.v11i1.7601

Establishing a Quality Measurement System for Cancer Care in Japan

Ensuring the quality of care is a major objective of cancer control policy. The Cancer Control Act 2006 placed responsibility on the Japanese government to maintain the quality of cancer care nationwide. To function as centers providing high-quality care, designated cancer care hospitals (397 hospitals as of April 2012) were instituted nationwide. Although they meet the structural standards, such as the presence of radiation equipment and palliative care teams, it remains unclear whether the designation has led to appropriate provision of care and optimal patient outcomes. A national system to examine the processes and outcomes of cancer care is under development. In 2007 and 2008, the Japanese Association of Clinical Cancer Centers publicly disclosed the 5-year survival of their member facilities with strict data quality standards, including sufficient follow-up of patients' vital status. The network of designated cancer care hospitals will follow this lead to provide a national outcome monitoring system. The processes of care have also been addressed by a government-funded research project. With the collaboration of clinical experts, 206 quality indicators have been developed for five major cancers in Japan (breast, colorectal, liver, lung and stomach) and palliative care. Each indicator described the target patients and standards of care for the patients, the provision of which was considered an aspect of quality. In 2012, the Cancer Registry Chapter of the Association of Prefectural Designated Cancer Care Hospitals instituted quality measurement using these indicators. These activities will soon lead to effective quality monitoring and improvement in Japan.

Organisational Theatre as Polyphonic Enterprise: Ambiguity &amp; Process in Health Care Transformation

This paper presents a longitudinal study of an organizational theatre intervention at an Australian cancer care hospital. Our work is grounded on differentiation and fragmentation paradigms of orga...