Oncologists In Japan Research Articles

The relationship between cost and the recommendation, refusal, and discontinuation of treatment for chronic myeloid leukemia and multiple myeloma in Japan: a cross-sectional exploratory survey

Aims This study aimed to ascertain the number of patients with chronic myelogenous leukemia (CML) and transplant-ineligible patients with multiple myeloma (MM) not recommended by their physicians for optimal drug treatment or who refuse, discontinue, reduce, or skip treatment owing to cost in Japan. Methods A cross-sectional survey was conducted among hematologists, hematologic oncologists, and oncologists in Japan treating ≥1 patient with CML or ≥5 transplant-ineligible patients with MM per year. Results A total of 212 physicians participated: 105 treating patients with CML and 107 treating transplant-ineligible patients with MM. While treatment cost did not lead to non-optimal treatment most patients, physicians reported that they recommended non-optimal treatment to 6.53% of their patients with CML and 1.41% of their transplant-ineligible patients with MM, that 1.51 and 0.35% of their patients, respectively, refused treatment and that 1.97 and 0.71% discontinued treatment owing to treatment cost. However, no significant differences in the effect of treatment cost on recommendation, discontinuation, refusal, or reduction of treatment were observed. Non-recommendation of optimal treatment owing to treatment cost was most common for third-line CML and fourth-line transplant-ineligible MM treatment. Discontinuation due to treatment cost was most common in third-line treatment for both. Conclusion Our results show that non-optimal treatment due to treatment cost occurs among some physicians in Japan for patients with CML and transplant-ineligible patients with MM, but it may be limited to a small percentage of patients. Further research is needed to identify the drivers of treatment decisions for physicians and patients, including those involving treatment cost.

Current status of hereditary breast and ovarian cancer practice among gynecologic oncologists in Japan: a nationwide survey by the Japan Society of Gynecologic Oncology (JSGO).

ObjectiveThe practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management.MethodsA Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC.ResultsA total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities.ConclusionGynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.

Surveillance of the current situation regarding influenza vaccination according to medical oncologists in Japan.

This study aimed to clarify the attitude of oncologists toward influenza vaccination and the current situation and issues regarding influenza vaccination for patients on chemotherapy in Japan. A web‐based survey of medical oncologists certified by the Japanese Society of Medical Oncology was conducted between November 1 and December 31, 2019. Of the 1369 medical oncologists who were invited to participate, 415 (30.3%) responded to our survey. The questionnaire comprised 4 sections: “oncologist characteristics,” “oncologist attitude toward influenza vaccines and the current status of influenza vaccination for cancer patients undergoing chemotherapy,” “incidence of influenza infection and associated treatment complications,” and “treatment policy for influenza infection.” In total, 153 (36.9%) physicians replied that they did not actively encourage influenza vaccination for patients undergoing chemotherapy. The primary reasons given were lack of evidence (48/153, 31.4%) and uncertainty of appropriate timing (46/153, 30.1%). There was diverse variation in the timing of vaccination and in the levels of encouragement based on the cancer location and medication type. Two hundred eighty‐three (68.2%) oncologists reported that their cancer patients had experienced influenza infection while undergoing chemotherapy, and 169 (40.7%) responded that their patients had experienced an administration delay or discontinuation of medication because of influenza infection. Our surveillance revealed some oncologists considered evidence regarding the administration of influenza vaccine to cancer patients undergoing chemotherapy (particularly the optimal timing and level of recommendation by cancer location and medication) to be lacking. It also exposed the adverse impact of influenza infection in cancer patients.

What motivated medical students and residents to become radiation oncologists in Japan?-Questionnaire report by the radiotherapy promotion committee of JASTRO.

This study aimed to clarify the motivations and timing of the decision to become radiation oncologists. Materials and methods: We conducted an online survey for new members of the Japanese Society for Radiation Oncology (JASTRO). Results: The response rate was 43.3%. Data of the 79 respondents who wanted to obtain a board-certification of JASTRO were analysed. We divided the respondents into two groups: Group A, those who entered a single radiation oncology department, and Group B, those who joined a radiology department in which the radiation oncology department and diagnostic radiology department were integrated. The most common period when respondents were most attracted to radiation oncology was “5th year of university” in Group A and “2nd year of junior residency” and “senior residency” in Group B. Furthermore, 79.5% of Group A and 40% of Group B chose periods before graduation from a university with a significant difference. The most common period when respondents made up their minds to become radiation oncologists was “2nd year of junior residency” in both groups. Internal medicine was the most common department to consider if they did not join the radiation oncology or radiology department. Conclusion: To increase the radiation oncologists, it is crucial to enhance clinical training in the fifth year of university for Group A and to continue an active approach to maintain interest in radiation oncology until the end of junior residency. In Group B facilities, it is desirable to provide undergraduates more opportunities to come in contact with radiation oncology.

National survey of radiation oncologists' practice patterns regarding hormone-naïve prostate cancer with bone metastases.

To explore radiation oncologists' attitudes and practice patterns of radiotherapy for hormone-naïve prostate cancer with bone metastases in Japan. An internet-based survey was distributed to board-certified radiation oncologists of the Japanese Society of Radiation Oncology. Three hypothetical cases were assumed: hormone-naïve prostate cancer with single, three or multiple non-symptomatic bone metastases. The respondents described their attitude regarding such cases, treatment methods and the radiotherapy dose fractionation that they would recommend. Among the 1013 board-certified radiation oncologists in Japan, 373 (36.8%) responded to the questionnaire. Most of the respondents (85.0%) believed that radiotherapy may be applicable as a primary treatment for hormone-naïve prostate cancer with bone metastases in some circumstances. For Case 1 (single bone metastasis), 55.0% of the respondents recommended radiotherapy for the prostate and bone metastasis. For Case 2 (three bone metastases), only 24.4% recommended radiotherapy for all lesions, and 31.4% recommended radiotherapy for the prostate only. For Case 3 (multiple bone metastases), 49.1% of the respondents stated that there was no indication for radiotherapy. However, 34% of the respondents still preferred to administer radiotherapy for the prostate. The radiotherapy techniques and dose fractionations varied widely among the respondents. Most of the respondent radiation oncologists believed that radiotherapy may be beneficial for hormone-naïve prostate cancer with bone metastases.

Nationwide survey of radiation therapy in Japan for lung cancer complicated with interstitial lung disease.

The purpose of this study was to clarify the opinions of radiation oncologists in Japan regarding treatment for lung cancer complicated with interstitial lung disease (ILD) by a questionnaire survey, and the risk of acute exacerbation (AE) after radiotherapy. Questionnaires were sent to all of the facilities in which radiation therapy is performed for lung cancer in Japan by using the mailing list of the Japanese Society for Radiation Oncology (JASTRO). The questionnaire survey was conducted to clarify who judges the existence of ILD, the indications for radiation therapy in cases of ILD-combined lung cancer, and the ratio of ILD-combined lung cancer in lung cancer patients treated with radiation therapy. Patients with ILD-combined lung cancer who received radiotherapy during the period from April 2014 to March 2015 were retrospectively analysed. Any cases of AE without any other obvious cause were included. ILD confirmation was performed by central radiologists using computed tomography images. A total of 47 facilities responded to the questionnaire. Radiation therapy was an option in cases of ILD-combined lung cancer in 39 (83%) of the facilities. The indication for radiation therapy was based on image findings in 35 (90%) of the 39 facilities in which radiation therapy was acceptable or was a choice in some cases of ILD. The final indication was based on the opinion of the pulmonologist in 29 (74%) of those 39 facilities. In fiscal year 2014, a total of 2128 patients in 38 facilities received chest irradiation. Seventy-eight (3.7%) of those 2128 patients had ILD-combined lung cancer. Sixty-seven patients were included in patient analysis. AE occurred in 5 patients (7.5%), and one of those 5 patients (20.0%) died from radiation-induced AE. The median period from radiotherapy to AE was 4 months (range, 2–7 months). The following four independent risk factors for AE were identified in univariate analysis: non-advanced age (<75 years), increased C-reactive protein level (≥0.3 mg/dl), adjuvant chemotherapy and ≥ Grade 2 radiation pneumonitis. Radiotherapy was an option for lung cancer even in cases with ILD in 83% (39/47) of the facilities in Japan. Seventy-eight (3.7%) of 2128 patients who received radiation therapy for lung cancer had ILD. Radiotherapy for ILD-combined lung cancer may induce AE at a substantial rate and AE can be life-threatening. Minimizing the risk of radiation pneumonitis might enable the risk of AE to be reduced.

Retrospective analysis of treatment patterns among recurrent/metastatic soft tissue sarcoma patients who consulted medical oncologists in Japan

BackgroundMany new antitumor drugs to treat soft tissue sarcoma (STS) were approved in the 2010's, and the need for the management of STS patients by medical oncologists has been increasing. Clinical data about the patterns of treatment of STS patients by medical oncologists in Japan are lacking. MethodsWe retrospectively reviewed the clinical records of STS patients who consulted the Department of Medical Oncology at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research between August 2012 and March 2017. The STS patients who received any systemic chemotherapy at the Department of Medical Oncology were enrolled in the analyses. We evaluated the details of the systemic chemotherapies used: treatment regimens, drugs, and treatment settings. We focused on the treatment lines and the prognoses of salvage chemotherapy administered for recurrent and/or metastatic STS patients. ResultsAmong the 273 patients who consulted the Department of Medical Oncology, 185 patients (68%) received some systemic chemotherapy; 20 patients received chemotherapy as definitive and/or in a perioperative setting, and 171 patients in a salvage setting. The median overall survival of the 171 recurrent and/or metastatic STS patients who received salvage chemotherapy was 14.1 months (95%CI: 10.4–17.8), and the median number of salvage chemotherapy treatment lines throughout their follow-up periods was two lines (range 1–9). ConclusionAbout two-thirds of the STS patients who consulted a medical oncologist underwent chemotherapy. In the recurrent and/or metastatic settings, newly approved drugs such as pazopanib were frequently used, and the prognoses of the STS patients treated by medical oncologists were similar to those reported in recent global clinical trials. For the better management of patients with STS, medical oncologists should contribute to the management as multidisciplinary team members.

A survey of practice in management of malignancy-related ascites in Japan.

Although ascites is a distressing complication observed commonly in the course of advanced cancer, there is no effective treatment established for malignancy-related ascites. We conducted a nationwide survey of cancer physicians in Japan who treat malignancy-related ascites in order to determine what kind of therapeutic approach is thought to be significant and what kind of diuretic prescriptions are thought to be standard for malignancy-related ascites. From 2017 to 2018, we sent a one-page memo to oncologists in Japan asking them to participate in a questionnaire-style survey that they could complete online. The significance of each of the nine representative interventions was measured on a 5-stage Likert scale. At the same time, participants were asked about what type and dosage of diuretics they thought to be standard as a treatment for malignancy-related ascites. Ultimately, 187 oncologists responded to our invitation. The interventions that were particularly significant were reducing hydration volume, paracentesis, and symptom management with analgesics. The respondents indicated that the importance of diuretics was significantly lower than that of these three interventions. Furthermore, 86.2% of the respondents in Japan regarded the use of loop diuretics ± aldosterone antagonists as the standard of diuretic therapy for malignancy-related ascites, and the most common regimen was 20 mg of oral furosemide ± 25 mg of spironolactone daily at the start, and 30–40 mg ± 50 mg daily at the time of initial escalation. Although our study revealed that the attitude of oncologists in Japan toward therapeutic options for malignancy-related ascites was nearly consistent with that of previous reports from other countries, it was newly found that they seemed to commonly be concerned with preventing overhydration of terminally ill cancer patients and that analgesics were also thought to be a significant form of intervention.

Changes in Physicians' Intrapersonal Empathy After a Communication Skills Training in Japan.

To investigate whether physicians' intrapersonal empathy increased after a communication skills training (CST) workshop. Participants were oncologists from across Japan with three or more years of clinical experience in oncology. They were recruited through the Internet and via direct contact by the workshop organizers. Participants attended 1 of 132 two-day CST workshops, held between November 2007 and March 2011. Prior to the workshop (baseline/T1), participants completed a survey with demographic questions, the Jefferson Scale of Physician Empathy (JSPE), and the Interpersonal Reactivity Index (IRI). The JSPE was administered again immediately after completion of the workshop (follow-up/T2). Then the JSPE and IRI were administered as part of a three-month follow-up (T3) survey. Changes in participants' mean total JSPE scores, JSPE subscale scores, and IRI subscale scores were compared using multivariate analysis of variance. Of the 507 workshop participants who received the three-month follow-up survey, 383 responded (response rate: 75.5%). Total JSPE scores and JSPE subscale scores at T2 and T3 were significantly higher than those at T1 (P < .01). IRI-Perspective Taking and IRI-Empathic Concern subscale scores increased significantly from T1 to T3 (P < .01), whereas IRI-Fantasy and IRI-Personal Distress subscale scores showed no significant changes. The JSPE scores of palliative care physician participants were significantly higher than those of medical oncologist participants at T1 and T3. No signifi cant differences were found by specialty at T2. The intrapersonal empathy of oncologists in Japan increased after a two-day CST workshop.

P3-335 - The implementation of cancer survivorship care for Japanese expats and those families in a private clinic in Shanghai

Our clinic offers medical treatment to Japanese expats and those families in Shanghai. China-resident Japanese cancer survivors occasionally consult us; however, their overseas medical needs and treatments have not been assessed comprehensively. The medical records were retrospectively reviewed on the cancer survivors who consulted our clinic between 2014 and 2016. We found 31 cancer survivors, including 22 (71%) males. The patients' age ranged from 34 to 86-year-old, and patients in their fifties were the most frequent. The tumors originated from 12 body sites; 8 (26%) tumors from the breast, and 7 (23%) tumors from the large intestine. 11 patients with cancer had been diagnosed at our clinic, and all of them were referred to Japan to undergo medical treatments; afterward, 6 patients of those returned to Shanghai expat. The medical care for cancer survivors provided at our clinic are as summarized below (overlap exists). In 4 expat patients, cancer chemotherapy had been continued in Shanghai. In cooperation with oncologists in Japan, our surgeon provided 3 postoperative breast cancer patients with endocrine therapy. One patient with gastric cancer had seen our internist for daily medical care, and he had visited medical oncologist concurrently for receiving cancer chemotherapy in Japan. 6 patients visited our clinic for cancer-related reasons; for recurrence survey (seeking endoscopic exam and/or tumor marker evaluation), or for relieving symptoms (restless legs syndrome, anxiety, or insomnia). 25 patients visited us having non-cancer related symptoms (common cold, epigastralgia, or diarrhea), or for requesting annual check-up and/or vaccine inoculation. The needs of cancer survivors were various. We could attain some cancer chemotherapy for expat patients. Besides chemotherapy, daily medical care and mental supports were required. We can keep eliminating cancer-care disparities for expat cancer survivors in Shanghai.

Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG).

This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.

Highlights for ESMO 40: celebration review for lifetime achievement awards

My work, my crucial achievement, has been in the management of the transition of the conduct of cancer research/management from basic researchers/surgeons to medical oncologists (figure 1). Figure 1 The Flower of Hope—the ESMO Lifetime Achievement Award. This transition can be divided into four categories: 1. The development, progression and consolidation of global Medical Oncology in Asian countries, especially in Japan. 2. Building a close collaboration with European Society of Medical Oncology (ESMO) and receiving strong support from ESMO, through (A) Adaptation of the ESMO/ASCO Core Curriculum in Medical Oncology,1 (B) Mutual ESMO/ Japanese Society of Medical Oncology (JSMO) joint symposia during their respective meetings, (C) making Annals of Oncology JSMO's official scientific publication,2 along with (D) my own work as an Associate Editor of Annals of Oncology (2011–2014), (E) my work as ESMO's National/Regional Representative and Membership Committee member (2005–2011). 3. Leadership of clinical research in Japan as a key opinion leader and primary investigator in IND (investigational new drug) trials and a chairman of the Japanese Clinical Oncology Group (JCOG; 2000–2009), organising a governmental clinical trial group; and the development of new gold standards in the treatment of malignant diseases, especially in thoracic malignancy by investigator-initiated randomised controlled clinical trials. 4. Encouraging translational research and the publication of numerous articles, especially in the area of the identification of molecular targets for anticancer drugs, as Chief of the Pharmacology Division in the National Cancer Center Research Institute. When I began my training in Medical Oncology, cancer research, including translational research, was conducted by basic researchers, and cancer treatment, including chemotherapy, was conducted by surgeons. There was no place for medical oncologists to play an active part in cancer research and treatment. ESMO was established 40 years ago and now has more than 10 000 professionals as members, and medical oncology has been recognised as …

PSY-1 - Long Term Care of Childhood Cancer Survivors: From the Pediatrician'S Viewpoints

As a result of treatment advances, almost 80% of children diagnosed with cancer become long-term survivors. In Japan, there are over 50,000 childhood cancer survivors (CCSs), or approximately one in 700 adults between the ages of 20 and 39 years has cancer experience. Treatment-related late effects are often clinically insidious for years or decades after the completion of cancer treatment. However many CCSs do not receive adequate risk-based medical care.To achieve effective follow-up for CCSs, truth-telling is an indispensable process for CCSs. Recently our study demonstrated that most pediatric oncologists conduct truth-telling of cancer diagnosis at least to adult CCSs now. One remaining well-described barrier is that CCSs themselves are not well informed regarding their potential risks for late effects. We need adequate risk-communications with CCSs.In our previous report the previous treatment hospitals were the most common visited medical facilities for even the adult CCSs (74% for female and 64% for male). However pediatric oncologists in Japan were increasingly uncomfortable with caring for adult CCSs as they age. One of the most important key words for successful transition is “sympathy”. There were a lot of voices to list “sympathetic ability” as an indispensable nature to succeed transition though the pediatricians' interviews. Most CCSs had a sense of hesitation in consulting the adult-based physician and many CCSs who were once introduced to an adult department returned to the pediatric department again.Transition to adult-based medicine is an urgent important issue as the Japan Pediatric Society made a statement. We need more discussions with medical oncologists to facilitate an effective bonding between CCSs and adult-based physicians. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify development of their late effects.

Pazopanib for Metastatic Soft Tissue Sarcoma (Sts) with or Without Denosumab

ABSTRACT Aim: Soft tissue sarcoma (STS) is such a rare neoplasm that we organized Cure-Sarcoma Therapuetic Consortium, including pahologists, gastroenerologists, surgeons and medical oncologists in Japan. We conducted a retrospective analysis on pazopanib for metastatic STS in order to examine the relationships of PFS with or without denosumab, also from the viewpoint of the first-line setting of pazopanib for metastatic diseases. Methods: In this study, the patients with metastatic STS treated with pazopanib from November 2012 till March 2014, conseutively, were retrospectively analyzed. Among the first four months, the starting dose of pazopanib was fixed at 800mg, but later it was changed to 400mg because of severe adverse events. Results: Forty six patients (23 leiomyosarcomas, 5 liposarcomas, 18 other subtypes) were identified. Median age was 56 years old (range 17-81), 38 females and 8 males, ECOG PS was 0/1 of 39 patients and 2/3 of 7 patients, 25 patients were in the first-line setting and 21 patients were in the second or later-line settings and 17 patients with multiple bone metastases were all treated with both pazopanib and denosumab. All the patients were evaluable by RECIST 1.1, and 24 patients were evalated as PR/SD but on the other hand, 22 patients showed PD/NE. After a median observation period of 27 weeks (range 6-69), OS was not reached yet (95% CI: 30.7-) and median PFS was 9.7 weeks (95%CI: 8.4-12.0). From the view point of PFS with response, PFS in PR and that in SD was similar. PFS showed no differences between 800mg vs 400mg (p=0.3449), leiomyosarcoma vs liposarcoma vs other subtypes (p=0.6296), and PS 0/1 vs 2/3 (p=0.7847). But PFS in PR/SD was longer (23.6 weeks) than that in SD/NE (6.1 weeks, p=0.0001). Finally, PFS with denosumab was not inferior to that without denosumab (p=0.25). Conclusions: Pazopanib including first-line setting for metastatic STS is effective and it is comparable with EORTC trials. The combination chemotherapy of pazopanib with denosumab is promising and further investigations are warranted. Disclosure: All authors have declared no conflicts of interest.

Prognostic value of isocitrate dehydrogenase 1, O6-methylguanine-DNA methyltransferase promoter methylation, and 1p19q co-deletion in Japanese malignant glioma patients

BackgroundTo determine the prognostic value of isocitrate dehydrogenase 1 (IDH1) mutation, O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and 1p/19q co-deletion in Japanese patients with malignant gliomas.MethodsWe studied 267 malignant gliomas, which included 171 glioblastomas (GBMs), 40 anaplastic astrocytomas (AAs), 30 anaplastic oligodendrogliomas (AOs), and 26 anaplastic oligoastrocytomas (AOAs). These malignant gliomas were divided into 2 groups (Group 1: GBM + AA, Group 2: AO + AOA) according to the presence of the oligodendroglioma component. We examined IDH1 mutation and MGMT promoter methylation in each group by direct sequencing and methylation-specific PCR, respectively. We further examined 1p/19q co-deletion in Group 2 by fluorescence in situ hybridization. Survival between groups was compared by Kaplan–Meier analysis.ResultsIn Group 1, patients with IDH1 mutations exhibited a significantly longer survival time than patients with wild-type IDH1. However, no significant difference was observed in Group 2, although patients with IDH1 mutations tended to show prolonged survival. For both Group 1 and Group 2, patients with MGMT methylation survived longer than those without this methylation. Further, patients with 1p/19q co-deletion showed significantly better outcome in Group 2.ConclusionsOur study confirms the utility of IDH1 mutations and MGMT methylation in predicting the prognosis of Group 1 patients (GBM + AA) and demonstrated that IDH1 mutations may serve as a more reliable prognostic factor for such patients. We also showed that MGMT methylation and 1p/19q co-deletion rather than IDH1 mutations were prognostic factors for Group 2 patients (AOA + AO). Our study suggests that patients survive longer if they have IDH1 mutations and undergo total resection. Further, irrespective of MGMT promoter methylation status, the prognosis of glioma patients can be improved if total resection is performed. Moreover, our study includes the largest number of Japanese patients with malignant gliomas that has been analyzed for these three markers. We believe that our findings will increase the awareness of oncologists in Japan of the value of these markers for predicting prognosis and designing appropriate therapeutic strategies for treating this highly fatal disease.

PSY2-2 - Role of Medical Oncologist in Local Medical Service and Medical Oncology Education

ABSTRACT Overall cancer treatment should be coordinated among a radiation oncologist, surgeon, and medical oncologist, where appropriate. Unfortunately, there were few medical oncologists in Japan mainly because of lack of the academic society like JSMO and divisions in medical schools and hospitals for medical oncology. Therefore, the multidisciplinary approach in treating cancers was inappropriate. Since 2006, more than 700 cancer drug therapy specialists (diplomates, Subspecialty Board of Medical oncology, JSMO) were fostered in Japan, and the medical oncologists with the diplomate are gradually distributed in local cancer core hospitals. The current role of the medical oncologists in the hospitals is diverse and it includes treatment and management of cancer chemotherapy, such as treatment of both common and rare advanced cancers, management of outpatient chemotherapy center, organization of the regimen review committee and tumor board, education of their medical staffs and patients etc. The expanding role of the medical oncologists in the management of cancer patients may contribute to the spread of standard cancer chemotherapy. However, the number of medical oncologist is still limited. Many challenges still exist, both within the hospital and in translating oncological, technological and societal change into the context of local medical society. Because the number of cancer patient is increasing in Japan, wide spread advances in oncology by oncology specialists is urgent matter. In this symposium, current and future roles of the medical oncologists in local cancer core hospitals and their role in medical oncology education should be discussed.

1316 POSTER Oral Chemotherapy Administration Practices in Ireland

Multivariate regression analysis was performed to evaluate the impact of the establishment of the Japanese regulatory agency Pharmaceuticals and Medical Devices Agency (PMDA) in 2004 with respect to the contents of guidance for proper usage. Results: From 91 approved oncology pharmaceuticals, we obtained 59 guidance for proper usage for 50 approved oncology pharmaceuticals. The median total number of pages in the guidance for proper usage was 48 (range, 11−98 pages). The proportions of pages in the guidance that discussed toxicity, drug information, and the results of registration trials were 30%, 26%, and 11%, respectively. After the PMDA was established, the total number of pages and the proportion of pages discussing the results of registration trials significantly increased (p = 0.007 and p = 0.002, respectively). On analyzing guidance published for different types of drugs, we observed that the total number of pages and the proportion of pages discussing toxicity in the case of molecular-targeted drugs was significantly greater (p < 0.001 and p = 0.008, respectively) than that for the other types of drugs, whereas the proportion of pages discussing indications was significantly lower (p = 0.001) than that for the other types. Conclusion: The guidance for proper usage distributed to medical oncologists in Japan include drug information that is not provided in package inserts. The establishment of the PMDA and the type of drugs for which the guidance for proper usage were distributed may have influenced the contents of and trends with regard to the guidance for proper usage.

Attitude and decision‐making process for use of acupuncture among clinical oncologists in Japan: questionnaire surveys

Attitude and decision‐making process for use of acupuncture among clinical oncologists in Japan: questionnaire surveys

The necessity of a comprehensive system of education for clinical oncologists in Japan

The necessity of a comprehensive system of education for clinical oncologists in Japan