MD Anderson Cancer Center
Japanese Medical Exchange Program
2018

Yoko Takahashi M.D.
Cancer Institute Hospital of JFCR
Breast Center, Breast Surgical Oncology

Personal Mission and Vision from JME Program 2018

●Mission（Japanese）
炎症性乳癌の治療の標準化を進める（English）
To progress standard treatment for Inflammatory breast cancer●Vision（Japanese）
患者を中心とした共同研究により日本における患者中心の炎症性乳癌センターを創る（English）
To create the highest quality patient centered IBC center in Japan by patient centeredcollaborative research1. Purpose
Personal Purposes of Japanese Medical Exchange 2018 (JME2018):
Through the program in MD Anderson Cancer Center (MDACC),
1. To understand the Team Oncology implemented in MD Anderson and discuss
about possible improvement for the clinical settings in Japan.
2. To develop understanding in leadership and career development and reflect on
my own career development.
3. To further develop knowledge in clinical, educational, and research aspects ofBreast oncology.

2. Methods
The training was conducted in MD Anderson from August 30 to October 5, 2018.
a. To study about team oncology, career development and leadership.
b. To form a multidisciplinary team of physicians, pharmacist and nurse, to develop aproject of oncology program by oral presentation
Participants
3 Physician (Breast surgeon, Oncologist, Radiologist), 2 pharmacists, 2 nurses
At the beginning
JME 2018 member are selected by ''1st Team Science Oncology Workshop Creating theBest Teams in Oncology Care for the Future'' by MDACC and Japan Team Oncology
Program at Showa University Hatanodai Campus from January 26 to 28 2018
In 2018 spring, I got a message to the effect that has been elected a member. It was a great
pleasure to me and an honor.

Dr. Naoto Ueno recommended us as below•Ask questions–Sometimes, it is important to explain why you are asking the questions.

–Not everybody has the answer.

–Ask the same questions to different people•

Ask your friends what they have learned, same experience but differentperspectives.
•Do not focus on comparing to Japan too much.

•Have your own opinions.

•It is okay to provide constructive criticism

Almost every section, we had a chance to ask questions. We are not good at English, butpeople who is working MD Anderson tried to understand what we want to ask them. It wasso helpful for us.
3. Program
MD Anderson had prepared a detailed program for us. Seven people may be lectured ingroups or sometimes divided into two groups, and furthermore in the actual visiting scene,many scenes to respond to the staff on a one-to-one.
Training programs on following topics
a. Check-in Visa Office
Technical Orientationb. following Nurses, pharmacists, and other medical staff
Breast Medical Oncology clinic
Breast Surgical Oncology clinic

Stem Cell Transplant round
Leukemia/Lymphoma Inpatient rounds
Breast Surgical Oncology operation room
Pathology Meeting
Radiation Oncology
Breast Imaging (Radiology)
Breast Survivorship Clinic
Infusion Therapy and ATC Infusion Clinic Nursing
Clinical Pharmacy
WOCN (wound ostomy continence nursing) Inpatient round
C. Conference
Breast Cancer Management Conference (Undiagnosed Breast Cancer)
Gynecology Conference
22nd Annual Interdisciplinary Conference on Supportive Care, Hospice and Palliative
Medicine
Nursing Quality and Patient Safety
D. Lecture on Nursing
Nursing leadership
Orientation of new nurses/maintaining competency
Governance
CNL Program/ Primary Team nursing/inpatient leadership
Nursing Ethics Round
E. Others
Antimicrobial Stewardship Discussion
Houston Hospice
CABI tour
Leadership lecture program by Janis Yadiny, Dr. Walter Baile and Carrie Cameron
・ Handling Difficult Conversations and Managing Conflict・ Mentoring・ Leadership Development

・ Leadership Development Career
Ethics Lecture by Dr. Theriault
Mentor/ Mentee meeting (Janis Yadiny / Dr. Mediget Teshome)
Dr. Naoto Ueno meeting
Patient empowerment: tea party for inflammatory breast cancer patients

4. ResultsGroup project
Since I learned through the program of 5 weeks, I made the presentation at the end. We
seven JME2018 members divided into two groups and made a presentation.
My group was four member, two physicians (breast surgeon/ radiologist), one pharmacist
and one nurse. What we learned through this program so many things, but our interestingthema was a Patient education. Although the general framework of our theme has been

decided, but, we have to talk about what kind of disease should I begin with, if we will take itbring back to Japan specifically? In deciding the details, I felt honestly conflict occurred.

However, as a result of repeated discussions, rather than targeting some diseases, how toeducate the elderly cancer patients by making it a theme. And the direction of thepresentation has come to light. Education for the elderly is also difficult due to individualdifferences. However, with the "Patient empowerment" being done at MD Anderson, it isbeneficial not only for the patient alone but also for medical professionals, we made apresentation on the subject "Patient Education for Older Patients Requiring Oral
Anti-Cancer Medication". Especially, considering Japanese elderly patient planned patient
education targeting over 75 years old. From the background of the era, we imagined thatpatients would be using smartphones and the Internet since I was young will be elderly now,
but I got an opinion that it might be difficult to use the phone. My impression is thatelectronization was advancing at MD Anderson, because we thought patient could send atext message in the medical record easily. But actually, there was an opinion that thefamily instead of elderly patients often made a reservation and send the text. In addition,
statistical evaluation was difficult when assembling clinical trials. Dr. Shen who isstatistician, gave us advice on how to compare. It divided into integrated patient educationgroup and individual education group, but for the first evaluation, the single arm might havebeen better. I wanted to make use of it in the future. here is no doubt that the word "patienteducation" no longer knows in Japan. It seems that there is a difference in understanding of‘patient empowerment’. However, as the number of elderly people in the future increases
and medical personnel are limited, we must educate cancer patients, especially elder
patient. Patient acquiring various powers gains many benefits for many people. Even after I
returned to Japan, I wanted to spread this. It was a valuable opportunity.

5. Future Prospects
Team Oncology
Through this training, what I felt was the high level of professionalism and good teamworkof MD Anderson staff. One of my purposes to learn teamwork, but fortunately I was able toengage with people from many occupations. There are many different basically systems
between MD Anderson and Japan, we cannot immediately change our systems what welearned at MD Anderson. However, the fundamental thing is common in many cases, forpatients and cancer research, I wanted to continue to do activities. In particular, regarding
patient education and patient empowerment, which was our presentation theme, it seems
to be beneficial for both patients and medical staffs. First of all, I wanted to aim for
introduction from my own facility. And it is important for the medical staff to feel rewarding,which seemed to lead to teamwork as well.
Leadership/ Career development, Mission/Vision
Through the JME2018 program, I received a lecture on leadership. From now on, whileworking as a member of the organization, I hope to improve my leadership skills and toadvance team oncology. And in a mentoring with Dr. Naoto Ueno, I was able to brush up mymission and vision. Based on these experiences, I would like to contribute to the treatmentof Inflammatory Breast Cancer in Japan as a way to go forward.
6. Acknowledgement
This work was supported by Oncology Education Project who supported the JME Program
2018 and Team Oncology Program (JTOP) staff. In particular, I would like to express mysincere thanks to Dr. Naoto Ueno and Dr. Joyce Neumann of MD Anderson Cancer Center,the Japanese staff who participate in JTOP Mr. Fueki and Dr. Ueno’s secretary Mrs. Marcy.
I also thank many other organizations foundation and individuals for their support for JME
2018 Program.