Over the past 10 years, cancer treatment has dramatically changed due to various reasons. The most remarkable change is the reduced duration of hospital stay, and another remarkable change is the sharp increase in the number of patients receiving chemotherapy at outpatient clinics. The mean hospital stay was about 30 days in 1997 but decreased to 15 days in 2007, and the number of patients receiving chemotherapy at outpatient clinics was about 3,000 in 1997 but increased to15,000 in 2007.This situation was not anticipated 15 years ago when National Cancer Center Hospital East was established; these changes have had a great impact on the operation of the hospital both in terms of human resources and space. In order to adapt to these changes, a new devision named Ambulatory Care Division was established in 2007; the activities of this division are providing outpatient chemotherapy and supportive care, including palliative, psychological, and nutritional care, and socioeconomic support. To solve the spatial constraints of the outpatient clinic, reconstruction of the hospital building was initiated in 2007 and is expected to be completed in 2009.
Because of the abovementioned shift in cancer treatment, particularly the shift from hospital-based chemotherapy to outpatient-based chemotherapy, supportive care needs to change from being hospital based to being community based. Therefore, we have initiated a project that will provide “outreach palliative care” in collaboration with Kashiwa Health Office and physician’s associations from 3 cities around Kashiwa. This project is termed Outreach Palliative Care Trial Integrated Regional Model (OPTIM) and is supported by The Strategic Outcome Research Program for Cancer Control,MHLW-Commission.
In 2004, a new 2-year obligatory postgraduate training for medical doctors was enforced. After this enforcement, the deficiency in the number of medical doctors in many fields of medicine, including basic research and clinical medicine, became evident. The unavailability of anesthesiologists is a representative example. The evident effect of this situation was reflected in the National Cancer Center in 2007 as a decrease in the number of applicants for residency. In addition, in 2007, a new program termed “cancer professional” that is related to the Cancer Control Act enforced in 2007 was implemented by the Ministry of Education, Culture, Science Sports and Technology. As a result, many universities and medical schools started to establish programs for oncology specialists, that in turn have lead to the recruitment of many members of our hospital. In fact, in 2007, 6 physicians were recruited to universities and 5 were promoted to different cancer centers, causing a deficiency in talented staff in our hospital.
Smooth application of the results of basic research to clinical practice is strongly desired worldwide. The group Research Center for Innovative Oncology is engaged in the development of a micelle drug delivery system (DDS), and clinical trials for 3 DDSs have commenced in the last few years. A new clinical trial for a cancer peptide vaccine that was developed by basic research performed at our institute was started in our hospital and another antibody therapy and new drug from a natural product are being considered for clinical trials. We have attempted to establish a support system for clinical trials by training research nurses, pharmacists, and data managers. Over the past several years, clinical trials for the development of anticancer drugs are being conducted internationally (global clinical trials). Supporting these trials is a difficult task. Meeting the requirements of stringency and language are other issues that require solutions. The management of investigator-initiated clinical trials that has been started in our hospital is another moment for strengthening the supporting system provided to clinical trials. Although the current situation is challenging, it is also very exciting because it is an opportunity for dramatic changes.
Finally, I would like to use this opportunity to express my sincere thanks to all members of our hospital who are working extremely hard to bring about innovations in novel cancer treatments (care) under extremely challenging conditions. I also would like to express many thanks to those in Tsukiji campus, National Cancer Center, and the Ministry of Health, Labour and Welfare who strongly support our activities.
Hiroyasu Esumi, M.D.
Director, National Cancer Center Hospital East
Table of Contents