Annual Report 2019

Division of Medical Support and Partnership

Masashi Kato, Jun Itami, Nobuyoshi Hiraoka, Hirokazu Takahashi, Rie Yamamoto, Hironobu Hashimoto, Yoichi Shimizu, Toshiyuki Minemura, Yoko Nakazawa, Manami Fujishita, Kumiko Saika, Ryoko Machii, Takashi Hanada, Emi Takeuchi, Risa Yamazaki, Kazuko Matsuda, Kaishi Satomi, Chieko Nagashima, Takatsugu Magara, Naoya Ikeno, Hiroshi Saito, Hiroaki Onaya, Hidenori Ojima, Saran Yoshida, Miki Takahashi, Taeko Aiko, Tokiko Iguchi, Hiroyo Ohchi, Mayumi Kobayashi, Ritsuko Chinda, Hiromi Nakamura, Shiho Hirai, Mamiko Maeshima, Mika Mizumoto, Yuri Yamauchi

Introduction

 The Division enhances partnerships among designated cancer hospitals to support all health professionals concerned with cancer control in Japan. The Medical Support and Partnership Section (MSPS) plays a unique role in supporting designated cancer hospitals in Japan. The Pathology Consultation Section (PCS) aims to perform human pathology research based on the histology of tumor cells and tumor-stromal cells to improve diagnostic pathology of the tumors. The Radiology Consultation Section (RCS) provides a consultation service and a cancer image reference database (NCC-CIR). A radiology consultation service is aimed at the improvement of the quality of diagnosis based on medical images. The NCC-CIR is a web-based reference database system of images of neoplasms for physicians, radiologists, and pathologists, providing medical diagnostic images and information together with pathology. The Outreach Radiation Oncology and Physics section (ORP) provides the following support programs for designated regional cancer centers and institutions participating in clinical trials: the Cancer Control Education and Training Section (CCETS) plays the role of planning and managing specialized and multidisciplinary training programs for health professionals in designated cancer hospitals, to promote a comprehensive and systematic cancer control program in Japan, and the Cancer Screening Management Section (CSMS) supports the development of quality assurance management of cancer screening programs, particularly nationwide programs, which are based on the Basic Cancer Control Plan.

Table 1. Training programs conducted from April 2019 to March 2020

The Team and What We Do

1. Networking among Designated Cancer Care Hospitals

 The MSPS has regularly held the liaison council of designated cancer hospitals and the palliative care committee to enhance partnerships among the designated cancer hospitals, and the PDCA Cycle Forum to improve the quality of cancer care in Japan.

2. Pathology consultation service

 The PCS received 661 cases requesting a specialist’s second opinion regarding histopathological diagnosis (2019.4 – 2020.3). There are 90 consultants registered, many of them highly recognized experts in specialty disciplines. One of these assigned as a consultant examines the slides and quickly sends back his or her opinion report to each client. Most of the clients expressed satisfaction with the content of the reports and this consultation system. We also selected typical or educational cases from accumulated archives and constructed a referential database.

3. Radiology consultation service

 Four consultation reports have been put together for requests mainly from the Chubu region. Head and neck malignant lesions, a spinal lesion and a retroperitoneal lesion were the subjects.

4. NCC-CIR

 The average number of effective accesses to this site was almost the same as that in 2016, about 100,000 per month, and 305 cases showed signs of cancer.

5. Radiotherapy case service

 Mailed dosimetry and on-site dosimetry were performed in 146 institutions and two institutions, respectively, at the ORP. All data of the institutions were within the permissible limit.

6. Quality assurance (QA) activities in cancer screening

1) The CSMS collected the information related to the implementation of cancer screening and its management situation using Checklists (CLs) as a structure indicator in quality assurance (QA) in municipalities. The CSMS also evaluated process indicators such as the workup rate and ranked those indicators in all cities by prefecture in order of goodness so that each city compares its indicators with those of other cities.

2) The CSMS examined the method of activating QA by prefectural initiatives and set up the website as a tool that supports the prefectural activity. In 2019, a prefecture-based database about CLs and process indicators, and the manual of QA for prefectural staff were placed on the website.

Research activities

1. The National Mortality follow-back survey

 The MSPS has conducted a population-based mortality follow-back survey to evaluate good death in Japan.

2. Development of the IMRT quality control support program

 The ORP have developed the Intensity Modulated Radiotherapy (IMRT) third-party mailed evaluation system by using the gamma index method to evaluate the dose distribution.

3. National cancer screening implementation status survey

 The CSMS surveyed and analyzed the implementation status of cancer screening (screening content and QA level) in prefectures and municipalities, summarized it as the national cancer screening implementation status data book <2018> and returned these evaluations.

Clinical trials

1. Support for clinical trials

 To support central radiological reviews in clinical trials, we have provided a system for receiving and sending DICOM imaging data between participating multi-centers and review boards since 2014. Ten clinical trials used this system in 2019.

2. The on-site dosimetry regarding the output dose of IMRT

 In Japan Clinical Oncology Group (JCOG1208, 1212, 1303, 1402, 1408), the ORP performed the postal dosimetry regarding the output dose of IMRT in 19 institutions.

Education

 The CCETS provides and evaluates various oncology professional training programs about chemotherapy, palliative care, and nursing care for nurses, pharmacists, and so on. The CCETS provides multidisciplinary training programs for Palliative Care Teams and Chemotherapy Teams. Community-based palliative care resources optimizer education, a project commissioned by the Ministry of Health, Labour and Welfare from 2016, is a unique program for health-related professionals who work towards palliative care collaboration in the community. The CSMS conducted training workshops for cancer workers in prefectures and municipalities. In addition, we provided guidance separately to prefectures that requested such guidance.

Future Prospects

 The MSPS will regularly conduct the National Mortality follow-back survey in the future. The CSMS continues implementation, surveillance, and support of cancer screening conducted by municipalities according to national cancer control and cancer screening measures, as well as quality control based on the actual understanding of cancer screening in occupational screening, and aims to conduct organized screening throughout the whole country. All sections will continue to be involved in our routine activities and education.

List of papers published in 2019

Journal

1. Nakazawa Y, Sakashita A, Kaizu M, Abo H, Ise Y, Shinada Y, Sugano K, Yamashiro A, Akizuki N, Kato M. A Self-Check Program Targeting Quality Improvement in a Hospital-Based Palliative Care Consultation Team, Japanese Society for Palliative Medicine: Issues Regarding Team Activities Identified through the Plan-Do-Check-Act Cycle. J Palliat Med, 23:359-367, 2020

2. Nishimura Y, Ishikura S, Shibata T, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh JI, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Ishikawa K, Shimizu H, Minemura T, Nakamura K, Hiraoka M. A phase II study of adaptive two-step intensity-modulated radiation therapy (IMRT) with chemotherapy for loco-regionally advanced nasopharyngeal cancer (JCOG1015). Int J Clin Oncol, 25:1250-1259, 2020

3. Machii R, Saika K. International comparison of lymphoid, myeloid leukaemia incidence. Jpn J Clin Oncol, 50:344-345, 2020

4. Hamatani Y, Takada Y, Miyamoto Y, Kawano Y, Anchi Y, Shibata T, Suzuki A, Nishikawa M, Ito H, Kato M, Shiga T, Fukumoto Y, Izumi C, Yasuda S, Ogawa H, Sugano Y, Anzai T. Development and Practical Test of Quality Indicators for Palliative Care in Patients With Chronic Heart Failure. Circ J, 84:584-591, 2020

5. Machii R, Saika K. Incidence rates of brain and central nervous system malignancy in the world from the Cancer Incidence in Five Continents XI. Jpn J Clin Oncol, 49:491-492, 2019

6. Sagawa M, Machii R, Nakayama T, Sugawara T, Ishibashi N, Mitomo H, Kondo T, Tabata T. The Prefectural Participation Rates of Lung Cancer Screening Had a Negative Correlation with the Lung Cancer Mortality Rates. Asian Pac J Cancer Prev, 20:855-861, 2019

7. Takada Y, Hamatani Y, Kawano Y, Anchi Y, Nakai M, Izumi C, Yasuda S, Ogawa H, Sugano Y, Anzai T, Shibata T, Suzuki A, Nishikawa M, Ito H, Kato M, Shiga T, Fukumoto Y. Development and validation of support tools for advance care planning in patients with chronic heart failure. Int J Palliat Nurs, 25:494-502, 2019

8. Takeuchi E, Shimizu M, Miyata K, Shimizu R, Matsunaga N, Moroi N, Fujisawa D, Mimura M, Kato M. A Content Analysis of Multidimensional Support Needs Regarding Fertility Among Cancer Patients: How Can Nonphysician Health Care Providers Support? J Adolesc Young Adult Oncol, 8:205-211, 2019