Universal Health Coverage for Cancer Care in the COVID-19 Age
Challenges and Outlook for Radiation Therapy in Japan
Rev.03 as of Sept.10■ Objectives of the Project:
In order to study the implementation of next-generation health care setting for the realization ofuniversal health coverage (UHC) for cancer care in the age of COVID-19, we will investigate theactual conditions (impediments) for intensity-modulated radiation therapy (IMRT) in designatedcancer care hospitals.
As a member of the Union for International Cancer Control (UICC), the Asia Cancer Forum (ACF)
has been continually engaged in policy recommendation activities and advocacy over the course ofmany years, holding conferences (http://www.jsco.or.jp/jpn/index/page/id/155) to seek ways toresolve challenges to achieving UHC in cancer care. Through this network we will conduct
domestic and international interviews and hold expert meetings, compiling a report that will set out
the groundwork to enable discussions on next-generation health care setting, and disseminate policy
recommendations at a global level on next-generation radiation therapy treatment.

■ Background to the Project and Recognition of the Issues by Asia Cancer Forum
While the recent disruption in the field of cancer care due to the COVID-19-related crisis isconsidered to be a manifestation of the challenges facing existing health care systems, it isnecessary to begin to consider the implementation of the next generation of health care setting that
improves access to care and improves the quality and lowers the cost of care with limited healthcare resources, with a view to treating patients with advanced stage disease, numbers of whom areexpected to increase due to interruptions in diagnosis and treatment. As a measure towards this aim,
as discussed at UICC, radiotherapy, which does not require a hospital bed or respiratory equipment
and does not affect the patient’s immunity to any great extent, has been attracting attention.
However, radiotherapy in Japan is not widely used at treatment sites compared to other countries.
Therefore, this study aims to identify the actual status of radiotherapy in Japan as a way to solve theproblems to realize UHC in cancer care. In particular, although designated cancer hospitals havebeen established in a comprehensive network around the country to serve as hubs for access to
medical care, in fact the proportion of these hospitals that have facilities capable of offering IMRT,
a high-precision form of radiation therapy, stands at only around 50%, and the utilization rate ofIMRT in the number of radiotherapy treatments is as low as around 10%. So what is causing thebottleneck to dissemination of IMRT? By carefully tracing the impediments to the implementationof IMRT, we consider it possible to identify the challenges of cancer care in Japan, where, despite
the talk of equalization, there are large regional disparities and true UHC for cancer care has yet tobe achieved. Consideration of a cancer treatment delivery system that optimizes medical resources
can be expected to contribute to the realization of UHC for cancer care not only in Japan, but also inAsia, where Japan should take the lead.
In addition, media reports on radiation therapy provided to celebrities who have died during theCOVID-19 crisis have revealed the fact that radiation therapy in Japan is not accurately understood
not only by the general public but also by medical professionals. For the construction of the nextgeneration medical system, it is necessary to understand from a scientific and sociologicalperspective that the lack of progress concerning social understanding of the nature of radiation
therapy is a unique challenge for Japan.
Medical personnel who are the essential driving force for the realization of UHC are anticipated to
be under considerable pressure in the future in the COVID-19 age. What is more, at facilities whereradiation therapy is being provided, new trends that adopt data-driven insights into the medical
personnel workforce model have emerged, and it is now necessary to collect information pertaining
to these emerging trends. In anticipation of a global workforce shortage, there are also somebudding systems, such as highly flexible medical workforce work-life balance systems that have
reduced on-site staffing requirements and provided effective care through cloud-based remotesystems. With recent advances in radiotherapy technology and software, the use of telemedicine cantransform care. It is time to give strong consideration to the growing demand for radiotherapy andhow to support radiotherapy sites with new solutions.
In emerging countries that do not have the infrastructure in place to deal with the COVID-19
emergency, there is also the possibility of a leapfrogging phenomenon, whereby a new system could
leapfrog the technological progress made by developed countries and spread at once. Utilizing theUICC network and also in collaboration with the IAEA’s Program of Action for Cancer Therapy(PACT), parallel surveys of the current situation in Asian countries will be implemented and thisproject aims to address this issue as a pressing global challenge and to set out a path to sustainablesolutions.

■Research Topics•Fact-finding survey into radiation therapy in Japan(In the current fiscal year a fact-finding survey will be implemented on the dissemination ofIMRT at designated cancer hospitals in Japan.)•Analysis of the challenges facing social acceptance of radiation therapy in Japan•

Collection of information on international trends in the development of next-generation
radiology systems and medical personnel•

Survey of the current status of radiotherapy in Asia and comparisons with challenges inJapan (survey in collaboration with UICC networks and the Program of Action for Cancer
Therapy (PACT))■ Project Manager:
Norie Kawahara

Representative Director, Asia Cancer Forum; Publicity Officer,UICC-Japan■ Sponsor:
Varian Medical Systems, Inc.

■ Commissioned Organization:
Asia Cancer Forum: http://www.asiacancerforum.org/ja/
Asia Cancer Forum aims to contribute to the improvement of cancer care in Asia by creating aninterdisciplinary international collaboration network for the collection and utilization of cancerrelated information, and engaging in projects related to activities to promoting cancer on the global
health agenda. In order to achieve these aims, Asia Cancer Forum is engaged in the following
initiatives.
(1) Holding of the Asia Cancer Forum (international meeting); (2) Educational activities atuniversities and research institutions; (3) Cancer prevention educational activities in school healthrelated classes; (4) Multinational cancer awareness surveys and analysis; (5) Construction of cancer
information sharing systems (for education/awareness-raising purposes); (6) Projects that areancillary or related to projects detailed in (1) to (5) above.

Representative Director:
Norie Kawahara

Public Relations Director, UICC-Japan;
Project Associate Professor, Institute for Advanced Studies on Asia,
The University of Tokyo

Directors:
Masaru Iwasaki

Vice President, Director, Center for Advancing Clinical Research
University of Yamanashi
Program Director, Project of Drug Discovery and Development
Japan Agency for Medical Research and Development (AMED)

Akira Nakagawara

CEO, SAGA Heavy Ion Medical Accelerator in Tosu (SAGA HIMAT)

Haruhiko Sugimura

Vice Director, Hamamatsu University School of Medicine, Professor,
Department of Tumor Pathology, Hamamatsu University School ofMedicine

Tohru Masui

Distinguished Visiting Professor, School of Medicine, Keio University

Shinjiro NozakiCompliance and Risk Management Officer, Office of the Regional Director
Western Pacific Regional Office, World Health Organization

Auditor:Akihiko KaseKase Tax Corporation, Representative Partner, Certified public tax accountants

Senior Fellow
Zen-u HottaSenior Research Fellow, Applied Research Institute , IncFellow
Ikuko KaseFellow, Asia Cancer Forum, Project Researcher ,National Cancer Institute,