Cancer in Japan

By Nagahiro Saijo, MD, PhD
Kinki University School of Medicine
Osaka, Japan

It is an exciting time for oncology in Japan. A law to help promote prevention and early detection of cancer was enacted on June 16, 2006, and took effect on April 1, 2007. The basic policies of this law also promote the full equality in medical care for all cases of cancer, and the support of cancer research. Because there is no subspecialty of oncology in Japan, medical and radiation oncology capabilities lag far behind those of Western countries. There are very few well-trained medical and radiation oncologists. To improve the situation, the Ministry of Health, Labor, and Welfare (MHLW) nominated core and hub hospitals and provided $60-65 million per year to equip them with essential resources for taking care of patients with cancer. The Ministry of Education, Culture, Sports, Science, and Technology (MEXT) began the Gan(Cancer) Professional Educational Plan to increase the number of medical and radiation oncologists in the country. MEXT provides $20 million per year to activate this plan and also mandated that each university must establish an oncology department. We hope that this increased support will provide for more positions for medical and radiation oncology in universities.

In addition to the action of the government, the Japanese Society of Medical Oncology (JSMO) began certifying specialists in medical oncology. For that purpose, JSMO used the ASCO/European Society of Medical Oncology (ESMO) core curriculum. Based on this model, JSMO offered educational seminars two or three times per year for oncologists seeking this certification. Also, the Best of ASCO^® meeting in Japan has been organized as an advanced course. After completing oral and written examinations, the number of certified medical oncologists increased to 306 at the end of April 2009. Although the pace of certification is slow, the field of medical oncology has steadily improved.

Another part of Japan’s recent cancerfighting law aims to provide full medical care for patients with cancer living all over Japan. It also recognizes the importance of palliative care for patients in the late stages of disease. It is still difficult to determine what kind of palliative care is best for these patients. There are very few quantitative and universally understandable methods of this kind of care.

In Japan, the government covers the cost of medical care equally for all patients. This is quite a different situation from other countries. As a result, it is rather difficult to attract patients for clinical trials. On the other hand, patients need new drugs to continue to improve cancer care for all. Government agencies, including the Cabinet Office, MEXT, MHLW, and the Ministry of Economy, Trade, and Industry (METI) provided a Five-year Strategy for the Development of Innovative Pharmaceuticals and Medical Devices in April 2009. The report stressed the importance of cooperation among industrial, governmental, and academic groups. To improve the infrastructure for clinical research and to promote such endeavors, the government has nominated 10 core and 30 hub hospitals for clinical trial promotion and offers $60 million per year for funding. MEXT started the Bridging Research Support Program to facilitate translational research. Seven universities have been nominated for this program. In addition, the Pharmaceuticals and Medical Devices Agency (PM DA) has been reformed and consolidated. The number of reviewers in PMDA has increased significantly. A new guideline on methods for the clinical evaluation of oncology drugs was activated on November 1, 2008. The guideline is almost equivalent to those of the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMEA). The Highly Advanced Medical Technology Assessment system was introduced to facilitate use of new drugs and treatment modalities. A revised Japanese trial guideline for clinical research was implemented in April 2009. The guideline coincided with global guidelines.

By these efforts, I am sure that cancer care in Japan will improve.