WHITE PAPERonCANCER CONTROL
Looking Back 15 Years of Japan’s Cancer

Executive Summary: Looking Back on “15 Years of Cancer Control”
1) 15 Years of Cancer Control—Steady Progress and Favorable Resultsʀ In the 15 years since the “Cancer Control Act” was enacted in 2006, measures to improvetreatment settings and relieve or resolve physical and social pain for cancer patients have beensteadily strengthened and have yielded many favorable results in Japan.
ʀ The age-adjusted mortality rate under age 75 1 has declined from 92.4 (in 2005) to 70.0 (in2019), 2 and the rates of persons receiving cancer screening for various cancer types haveincreased; for instance, the rate of women receiving lung cancer screening has increased from
23.0% to 45.6%. 3
ʀ As health care delivery systems to eliminate disparities in cancer care have been developed, thenumber of medical institutions designated as “core cancer hospitals” now exceeds 400
nationwide. Measures against pediatric cancer have also been strengthened, and 15 medical
institutions located throughout Japan have been designated as “core hospitals for pediatriccancer” since 2012.
ʀ With the expansion of care delivery systems, including establishment of “palliative care teams”
in the core cancer hospitals throughout Japan, 4 according to a survey, the “difficulty” thatphysicians and other health care providers face when providing palliative care has consistentlyreduced. 5
ʀ Steady progress has also been made in “Patient and Public Involvement (PPI)” 6 toward
policymaking relating to cancer. The Cancer Control Act ensures opportunities for patients andtheir family members to participate in the Anti-cancer Measures Promotion Council Meeting ofਕ޳ߑ੔͗‫خ‬६ਕ޳ͳಋͣͲ͍ͮͪ৖߻Ͷࣰ‫͠ݳ‬ΗͪͲ͍Θ͑ࢰ๤ིɽҡ͵Ζॄ஄Ώ఼࣎͵ʹΝർֳͤΖͪΌͶ༽͏
Ζʤࢂߡʁhttps://ganjoho.jp/reg_stat/statistics/qa_words/word/nenreityouseisibouritu.htmlʥ
2ࠅཱི͗Ξ‫ڂݜ‬ιϱνʖ ͗Ξ৚ๅγʖϑη Web γ΢φʰ౐ಕැ‫ݟ‬พ 75 ࡂາຮ೧ྺ௒੖ࢰ๤ིʱΓΕ
ʤhttps://ganjoho.jp/reg_stat/statistics/stat/age-adjusted.htmlʥ
3ҥ͗Ξɼ഑͗Ξɼ୉ௐ͗Ξɼ೗͗Ξɼࢢ‫ٸ‬ᰏ͗Ξ౵ɼ͏ͥΗ͹͗Ξझ΍‫ݗ‬ਏणਏིͺրવ͢ͱ͏Ζɽࠅཱི͗Ξ‫ڂݜ‬ιϱνʖ ͗Ξ৚ๅγʖϑη Web γ΢φʰસࠅ͹णਏིʤ2010 ೧ɼ2013 ೧ɼ2016 ೧ɼ2019 ೧ʥʱΓΕ
ʤhttps://ganjoho.jp/reg_stat/statistics/stat/screening/screening.htmlʥ
4ʰ؉࿪ίΠਏྏՅࢋ಩ड़णཀྵࢬઅ͹ྩ‫਼ܯ‬ͺɼೖຌϙηϒη؉࿪ίΠ‫ڢ‬ճ͹௒΄ͶΓΖͳɼ2002 ೧͹ 22 ࢬઅ͖Δ2012 ೧ͺ 168 ࢬઅɼ2016 ೧Ͷͺ 231 ࢬઅͶΉͲଁՅͪ͢ʱ
ʤ஦ᖔཁӋࢢΆ͖ʰ؉࿪ίΠοʖϞ͹͞͹ 10 ೧ʱʲϙηϒηʀ؉࿪ίΠപॽ 2018ʳ੪քऀʥ5ࠅཱི͗Ξ‫ڂݜ‬ιϱνʖWeb γ΢φʰ͗ΞਏྏͶ‫ܠ‬ΚΖҫࢥ͹؉࿪ίΠஎࣟʀࠖೋ‫״‬Ν௒ࠬʱ౵ΓΕ
ʤhttps://www.ncc.go.jp/jp/information/pr_release/2017/1102/index.htmlʥ
6‫ं׳‬ʀࢤ຿ࢂժ͹ଲেͳ͵Ζਕʓ͹൥ҕͶͯ͏ͱͺ༹ʓ͵ߡ͓๏͍͗ΕಚΖ͗ɼྭ͓ͻ NHS England ͺʰʲPatientsand Publicʳͳ͏͑‫ݶ‬ཁͶͺɼղ‫ंޤ‬ΏՊଔΝ‫؜‬ΌɼγʖϑηΝཤ༽͢ͱ͏Ζɼ͍Ζ͏ͺগཔཤ༽ͤΖՆ೵੓͹͍Ζͤ΄ͱ͹ਕ͗‫؜‬ΉΗΖɽҫྏʀղ‫ޤ‬γʖϑη͹ཤ༽ंͺͳ͘Ͷʲ‫ݩܨ‬๝͖͵઒໵Պʳͳ‫ͻݼ‬ΗΖɽNHS ΢ϱήϧϱχͺɼ൶Δ͹‫͖ݩܨ‬Δҟ͠ΗΖ߫‫ݛ‬Ν߶͚඲Ճ͢ͱ͏ΖʱͳnPatient and Public Participation Policy|Ͷ໎‫͏ͱ͢ى‬Ζ
ʤhttps://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-policy.pdfʥ
ɽ11the Ministry of Health, Labour and Welfare. Some prefectures also elect committee members fortheir Anti-cancer Measures Promotion Council Meeting from the public. 72) 15 Years of Cancer Control—Next Challenges
ʀ Despite such positive progress and results of cancer control in Japan, on the other hand, the nextchallenges that require more efforts are becoming clear.
ʀ Currently, Japan’s 5-year survival rates of some cancer types, such as adult lymphoid andmyeloid malignant diseases, fall behind some countries, including the U.S.. Further progress,
including treatment development, is particularly expected for these cancer types.
ʀ Although efforts to eliminate disparities in cancer care have yielded some favorable results,
inter-prefectural disparities, including the age-adjusted mortality rate under age 75, definitelyexist; further efforts are required to eliminate such “cancer disparities” among prefectures.8
ʀ In an international comparison study on palliative care,9 Japan ranks 14th internationally in thepalliative and healthcare environment category and 16th in the quality of care category, whichfalls behind some Asian countries, such as Taiwan and Singapore. Extra efforts to broaden thedelivery system of palliative care and improve its quality, including the usage environment ofanalgesic drugs, are expected.
ʀ As for “Patient and Public Involvement (PPI)” toward policymaking, although the opportunities
have steadily been expanding, when it is compared to some countries such as the U.K., forinstance, the transparency relating to the selection system of committee members from patientsand their family members remains low. The system to enhance empowerment,10 such as
training of patient representative committee members who participate in the policy meeting, isalso weak.
ʀ Regarding the “Basic Plan to Promote Cancer Control Programs” as an administrative plan,
while the revisions have been made from the first term (FY 2007-2011) to the third term (FY2017-2022), the nature of the basic plan has altered from an “objective setting-oriented” planಝఈඉӨཤ‫׈‬ಊ๑ਕ͗Ξ੕ࡨγϝρφ͹௒ࠬͶΓΗͻɼ2017 ೧఼࣎Ͷ͕͏ͱɼঙ͵͚ͳ΍ 40 ͹౐ಕැ‫ݟ‬Ͷ͕͏ͱɼ͗ΞଲࡨͶ‫ܐ‬Ζճ٠ରͶ‫ं׳‬ʀࢤ຿җҽ͗ࢂՅ͢ͱ͏Ζʤࢂߡʁhttp://cpsum.org/pdf/Pref_Karte_2017.pdfʥɽ8ྭ͓ͻɼ75 ࡂາຮ೧ྺ௒੖ࢰ๤ི͹࠹΍ఁ͏ௗ໼‫ݟ‬ͺ 58.9ʤ2019 ೧ʥɼ࠹΍߶͏੪ਁ‫ݟ‬ͺ 90.8ʤಋʥͳ͵ͮͱ͏Ζɽʤࢂߡʁhttps://ganjoho.jp/reg_stat/statistics/data/dl/index.html#pref_mortalityʥ
9nTHE 2015 QUALITY OF DEATH INDEX RANKING PALLIATIVE CARE ACROSS THE WORLD KEY
FINDINGS INFOGRAPHIC” Economist Intelligence Unit study, commissioned by the Lien Foundation10ΦϱϏϭʖϟϱφʤEmpowermentʥͳͺ‫ं׳‬େනҗҽͶଲ͢ͱɼᶅ੕ࡨ఑‫ʹ͵ݶ‬͹ऀճదηΫϩΝ֭ಚͦ͠ɼᶆͨ
͹‫ݘ‬ཤΝߨ࢘Ͳ͘ΖΓ͑͵‫ڧ؂‬ড়݇Ν੖ඍ͢ɼᶇ‫ݘ‬ཤߨ࢘͹ͪΌͶචགྷ͵घஊΏ৚ๅΝ఑‫ͤڛ‬Ζ͞ͳͲɼऀճΝ‫׈‬੓Կ
ͦ͠Ζ͞ͳͲ͍Ζɽ
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(e.g., 20% reduction of the age-adjusted mortality rate under age 75)11 to a “philosophyoriented” plan where policy goals are not set numerically, which makes it difficult to evaluateresults. In this basic plan, “prevention” and “coexistence with cancer” are emphasized, and“radical cure” is not stated as a policy goal.12
ʀ Furthermore, for both “first term (FY 2007-2011)” and “second term (FY 2012-2016)” Basic
Plan to Promote Cancer Control Programs, the national government did not make evaluations
and reports on the input (injected resources), output (activity performance) and outcome(results)13 after the end of these terms. Efforts toward policy research by academics who study
these fields including university researchers were also limited. The way to review the plan,
including assessing the cost-effectiveness, needs work.

3) Proposal: 5 Suggestions for the Next 15 Yearsʀ Based on the above favorable results and remaining challenges from the last 15 years of cancer
control in Japan, we would like to propose to proceed the efforts below to persons in both thegovernment and private sector involved with cancer control in this white paper.
(1) In the next “Basic Plan to Promote Cancer Control Programs,” it is desirable to set numericalgoals to enable evaluation and validation of outcomes (results) of measures, including 5-year
survival rates. From the viewpoint of international comparison, it is particularly desirable that theenhancement of efforts to improve the status of cancer types with survival rates falling behind isstated as a goal. Each prefectural “Basic Plan to Promote Cancer Control Programs” is also
expected to have numerical goals, aiming to establish a system enabling evaluation of theoutcomes (results) as policies.
(2) Since it has become evident that there are disparities in prevalence rate among prefectures, aswell as differences in the organizational system concerning the cancer control planning, Japanneeds to develop measures for further improvement in the policymaking functions of eachprefecture, using the efforts made by the Centers for Disease Control and Prevention (CDC) in the11ʰ໪ඬઅఈ‫ଁ߃݊ܗ‬਒੕ࡨͺʲ໪ඬͶΓΖ؇ཀྵ(management by objectives)ʳͳ͏͑‫ܨ‬Ө؇ཀྵघ๑Ν༽͏ͱ͏ΖͪΌ໪ඬ؇ཀྵ‫߃݊ܗ‬੕ࡨͳ‫ݶ‬ΚΗΖ͞ͳ΍͍Ζ͗ɼϖϩηϕϫϠʖεϥϱͺॊཔ͹݊߃؇ཀྵద൅૟Ν୦‫ͱ͢٭‬ϚφϞΠρϕ‫ܗ‬͹݊߃Ͱ͚ΕΝΌͤ͡΍͹Ͳ͍Ζ͹ͲɼຌߚͲͺ͍͓ͱʲ؇ཀྵʳͳ͏͑‫ݶ‬ཁΝ༽͏ͥ໪ඬઅఈ‫ޢ༽͑͏ͳܗ‬Νࡀ༽͢
ͱ͏Ζɽʱʤຌ‫ڰ‬๝Ά͖ʰ໪ඬઅఈ‫ଁ߃݊ܗ‬਒੕ࡨ͹ࠅࡏർֳʱʲೖຌӶਫ਼ָࡸࢿʳ2002 ೧ 57 ‫ ת‬2 ߺ p. 498-504ʥ
12ྭ͓ͻɼ୊ࢀ‫خغ‬ຌ‫ܯ‬ժͶ͕͏ͱͺʰ‫ڠ‬ਫ਼ʱ͹ช‫ ͗ݶ‬9 ՗ॶౌ৖ͤΖ͹Ͷଲ͢ͱɼʰ࣑ࠞʱ͹ช‫ݶ‬͹‫ࡎى‬ͺҲ՗ॶͶͳʹΉͮͱ͏Ζ͞ͳͺɼ‫خ‬ຌ๑੏ఈҐ઴ɼ؉࿪ίΠ͹఑‫ڛ‬Ώ͗Ξҫྏ͹‫ͱۋ‬ΞԿͶॉ෾͵੕ࡨదી஖͗ߪͣΔΗ͵͖ͮͪൕ঴͖Δɼʰ‫ڠ‬ਫ਼ʱͶྙ఼͹஖͖Ηͪ‫ܯ‬ժͳ͵ͮͱ͏Ζ͞ͳΝࣖࠨ͢ͱ͏Ζɽ13ೖຌࠅ಼Ͷ͕͏ͱͺ༹ʓ͵༃͗ҟ͠Ηͱ͏Ζ͗ɼೖຌ੕ැͲͺɼྭ͓ͻɼ΢ϱϕρφͺʰ༩ࢋʱɼΠΤφϕρφͺʰ‫׈‬ಊࣰ੹ʱɼΠΤφΩϞͺʰ‫׈‬ಊࣰ੹͗΍ͪΔͤয়‫ڱ‬͹รԿɼਕ͹ߨಊร༲ɼͨ͹ଠ੔ՎʱͳͨΗͩΗ͹༽‫ޢ‬Ͷͯ͘ɼઈ໎͗෉͠ΗΖίʖη͗‫ݡ‬ΔΗΖʤࢂߡʁhttps://www.kantei.go.jp/jp/singi/it2/ebpm/dai5/sankou1.pdfʥ

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U.S. as a reference, for instance. At the same time, it is considered that the prefectures wherenumerical values of the age-adjusted mortality rate under age 75, etc. fall behind the otherprefectures particularly need extra measures to enhance cancer control. The national governmentis therefore expected to advance consideration on intensive financial support to such prefectures.
(3) With respect to patient involvement in the “cancer control” policymaking process at the nationaland prefectural levels, using the efforts in other countries including the U.K. as references, thefollowing suggestions are strongly recommended: (1) aim for a system that ensures bettertransparency, fairness, and other relevant qualities on standards and procedures relating to theappointment of patient representative committee members, and (2) enrich systems relating totraining/information provided to patient and family representative committee members from theviewpoint of enhancing the empowerment of patient representatives.
(4) To improve the molarity rate, etc. of cancer patients, research and development of drugs andtreatment development, as well as early detection of cancer and individual behavior changes, areextremely important. Since the Basic Plan to Promote Cancer Control Programs is positioned

above the “10-year Strategy of Cancer Research” and other relevant plans, 14 it is desirable to state
the next challenges and policy directions of research and development and treatment development
more specifically. 15 From these viewpoints to formulate the “Fourth Term of the Basic Plan toPromote Cancer Control Programs,” it is strongly expected to resume consideration in the “CancerResearch Expert Panel” held from FY 2011 to 2012 under the Anti-cancer Measures Promotion
Council Meeting and to newly establish a platform for patient support organization members toexchange opinions about challenges around cancer research (“Research Advocates ExpertCommittee” [provisional name]), 16 for instances.
(5) Some Social challenges, including “pursuing the balance between treatment and work” that

happens on cancer patients, are also common in patients with diseases other than cancer. Taking
advantage of the establishment of so-called, the “Cerebrovascular and Cardiovascular DiseaseControl Act” and other relevant matters, further collaborative policymaking with other disease઴फ़͹௪Εɼʰ࣑ࠞʱΝ॑ࢻͪ͗͢Ξଲࡨ͗݃Վͳ͢ͱʰ͗Ξೋ຿ʱΝਫ਼ΞͲ͢Ήͮͪ͞ͳ΃͹ൕ঴͗ɼʰ͗Ξଲࡨ‫خ‬ຌ๑ʱ੏ఈ͹ഐ‫ܢ‬Ͷ͍ͮͪ͞ͳ͖Δɼಋ๑Ͷ‫͚͗Ͱخ‬Ξଲࡨਬ਒‫خ‬ຌ‫ܯ‬ժͺ‫ं׳‬͹ QOL ͹րવΏɼ‫ं׳‬͹ਫ਼‫׈‬Ͷ‫ؖ‬ΚΖऀճద՟ୌ͹մ݀Ν॑ࢻ͢ɼҲ๏Ͳ‫ڂݜ‬ʀ࣑ྏ֋൅΃͹‫ٶݶ‬ͺ๣͚͢ɼ͞͹྘ҮͺԾҒ‫ܯ‬ժͲ͍Ζʰ͗Ξ‫ ڂݜ‬10͖೧કྲྀʱ౵Ͷҗ͸ΔΗΖܑ޴͗‫ݡ‬ΔΗΖɽ15ΨώϜ୉౹྘ʤ౲࣎ʥ͗ʰธࠅΝ͗Ξ͹࣑༌ͤΖࠅͶ͢Γ͑ʱͳफ़΄ɼPrecision Medicine Initiative ౵͹੕ࡨΝਬ͢਒Όͪ͞ͳͺɼ஦ԟ੕ැ͹͗ΞଲࡨͶ͕͜Ζࠕ‫ޛ‬͹ༀׄΝߡ͓Ζ৏ͲࣖࠨదͲ͍Ζɽ
ʤhttps://www.mixonline.jp/tabid55.html?artid=53629ʥ
16ྭ͓ͻɼธࠅ͹ࠅཱི͗Ξ‫( ॶڂݜ‬National Cancer Institute, NCI)ͺɼʰNCI ϨγʖοʀΠχϚίʖφ‫ڢ‬٠ճʱ(theNCI Council of Research Advocates, NCRA)ΝӣӨ͢ͱ͕Εɼธࠅ࿊๞੕ැͶ͕͜Ζ༏Ҳ͹ΠχϚίʖφ͹ϨʖξʖΝॄΌͪࣀ໲җҽճͳ͢ͱɼ婷 ͗Ξ‫ڂݜ‬ΝखΕ‫ঀ͚ת‬໲ୌͶ‫ͤؖ‬Ζқ‫׷ިݡ‬ɼᶆ ࠅཱི͗Ξ‫ॶڂݜ‬ௗ‫΃ׯ‬͹ঁ‫ݶ‬ɼ౵Νߨ
ͮͱ͏Ζɽͪͫ͢ɼNCRA ͹җҽ΃͹म೜ͺɼ͗Ξ‫ڂݜ‬Ώ੕ࡨͶ‫ͤؖ‬Ζ઒໵எࣟΝ༙͢ͱ͏Ζ͞ͳ͗གྷ݇ͳ͵ͮͱ͏
Ζɽʤࢂߡʁʰྡজ‫ڂݜ‬౵Ͷ͕͜Ζ‫ं׳‬ʀࢤ຿ࢂժͶ‫ͤؖ‬Ζಊ޴௒ࠬๅࠄॽʱฑ੔ 31 ೧ɼEY ৿ೖຌ༙‫੻ݸ‬೜؄ࠬ๑ਕʥ144

areas and implementation of policies beyond the barriers of disease types are expected in order toadvance the policy responses to psychological and social challenges where patients with chronic
diseases other than cancer/lifestyle-related diseases and those involved with such patients face incommon.

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