Cancer first became the top cause of death in Japan in 1981. Since then, it has remained in the top spot, with cancer now responsible for a third of all deaths in Japan. With the aging population, the number of cancer sufferers is expected to increase. However, improving treatment methods and an improved awareness of the importance of early detection have resulted in higher survival rates. Now, over 60% of cancer patients survive for more than 5 years. It has been said that Japan is arguably a “society that lives with cancer.”
Palliative care, as defined by the 1989 WHO standards, was the “holistic care and support for patients who do not respond to treatments with the aim of curing their illnesses.” This had the tacit meaning of terminal care. In Japan some years ago, doctors who have diagnosed cancer in their patients do not often reveal this diagnosis. In 2002, the WHO definition was expanded to include the “patient and family” for the “early assessment of bodily, psychosocial, spiritual problems with the goal of increasing the quality of life.” Currently, a concise definition of palliative care from the Japanese Ministry of Health, Labor and Welfare (MHLW) is: “Alleviating the bodily and emotional pain associated with illness.”
Himself a sufferer of malignant lymphoma, Shinsuke Amano is the director of a patient support group ‘Group Nexus Japan’ based in Setagaya, Tokyo. He reveals a response that patients and their family often face from their doctor during treatment. Patients complaining of unbearable pain and a desire to take up palliative care are often responded with: “Palliative care is too early for you. Keep fighting the illness and bear with the treatment.” Families are often led to believe that palliative care necessarily equates to giving up on treatment.
With recent shifts in palliative care thinking, palliative care is now in step with treatments from the beginning of diagnosis. With this, new misunderstandings may arise. The director of the Japanese Society for Palliative Medicine (JPSM), Toyoshi Hosokawa, who is also a professor at the Kyoto Prefectural University of Medicine, says: “Alleviation of the pain from the cancer as well as the side effects from cancer treatment all fall under palliative care. The treatments that doctors provide is also one aspect of palliative medicine.” The JPSM is increasing membership, especially targeting doctors who graduated between 2 to 5 years ago.
Japan is also instituting a new anti-cancer program, and within this program, palliative care is set to carry a bigger role, with an emphasis on increasing palliative care access from the beginning of cancer diagnosis. Currently, plans are underway to incorporate palliative care centres into the budget.
This article was first published on the website of the Asia Pacific Hospice Palliative Care Network.