Annual Report 2018

Supportive Care Development Center

Narikazu Boku, Emi Fujii, Michiko Arai, Naoko Inamura, Kumie Sakihara, Megumi Hakozaki, Hiromi Takada, Shiori Yamaoka, Ayaka Shida, Mami Akutsu, Kiyomi Kawase, Chihoko Hasegawa, Chiyuki Sasaki, Yasuko Abiru, Naoko Arii, Erika Onuki, Miwako Saito, Kurumi Jo, Momoko Takahashi, Aya Fukuoka

Introduction

 During the treatment and management of cancer patients, there are various unmet needs which cannot be solved by each patient just consulting a doctor; it is generally recognized that taking a team approach to these problems is very important. In September 2016, the Supportive Care Development Center was opened as the team medicine base in the National Cancer Center Hospital. We are supplying many kinds of support to not only patients but also to their families in collaboration with doctors and other team members consisting of many dedicated professionals.

The Team and What We Do

 The number of patients and their families visiting our department has been increasing gradually, reaching 142.3/day in March 2019. The average monthly number of users of each standing program between April 2018 and March 2019 was Preoperative Management (631.5), Nurse Consultation (123.1), Consultation Counselling and Support Center (387.8), Pharmacist Consultation (314.5), Nutritionist Consultation (74.8), Rehabilitation (22.6), Appearance Center (30.8), Palliative Medicine (151.7), Psycho-Oncology (283.5), Anesthesiology (429.5), Lymphedema Management (83.9) and Physicians Referral Service Office (65.3). We have regular classes for Adolescent & Young Adult, Pain Care, Support for Children and Parents, Nutrition, Anti-Cancer Agents, Pancreato-biliary Cancer, Body Image for Breast Cancer Patients, Relaxation, Lymphedema Management. Seventynine patients used the fertility preserving program for one year after its establishment at the end of 2017. Considering that we should be aware of our research and be a model for cancer care staff in other hospitals, we continue revising our daily duty work as a result of the PDCA (plando-check-act) cycle. Actually, after we revised the checklist for preoperative management of gastric cancer, there were no overlooked points such as laboratory tests between March and September 2018. Furthermore, we conducted an Exhibition of Ideas for Life with the main theme of "Work" on March 16. 2019.

Research activities

• As the result of screening about symptoms and mental distress in 19,267 first visit patients between September 2016 and November 2017, 1,997 (10.4%) patients were recommended to visit the supportive care development center to receive some kind of consultation. However, actually, 392 patients came to our center. Patients who visited our center had significantly more mental stress and less physical pain than those who did not.
• Looking at the actual medical procedures for 1,045 first visit patients after excluding patients who live outside of the Kanto area showed that 71 of 584 (12%) patients visiting surgical departments and 62 of 242 (26%) patients visiting medical departments returned home after the first visit without receiving any medical intervention in our hospital.
• In the Pharmacist's Consultation, we are developing tools using "Cloud" for instruction and evaluation of self-management of patients receiving oral anti-cancer agents. Initial 6 patients answered the questions, "How much do you understand?" about 4 points. Among the total 24 (6 patients x 4) points, one patient answered, "I do not understand well" for only one point. The time required for instruction was 17 minutes on average, but it was longer in female patients, elderly patients, patients after operations and patients having symptoms.

The Team and What We Do

 Considering that we should be aware of our research and be a model for cancer care staff in other hospitals, we continue to revise our daily duty work as a result of the PDCA (plan-docheck-act) cycle.

Clinical trials

 The protocol of retrospective studies for evaluating the clinical activities of Supportive Care Development Center was approved at the end of 2017. We conducted several retrospective studies described above.

Education

 New staff and three nurses from three hospital wards participate in the nurse consultation and pre-operative management programs and receive on-the- job training under the supervision of the staff of the Supportive Care Development Center.

Future prospects

 We continuously try to improve and newly develop our programs and to be a model for other hospitals taking care of cancer patients in Japan, and promoting collaboration with the patient's regional medical facilities.

Figure 1. Activity of each program at the Supportive Care Development Center (number of patients)