Cancer Nursing ProfileJapan
Japanese Society ofCancer Nursing

Prof. Hiroko Komatsukomah@sfc.keio.ac.jp

INTRODUCTION
Japan is an island country located in the Pacific Ocean and consisting of four large islands andnumerous smaller ones. It covers the total area of 377,915 square kilometers. Japan is the secondmost populous island country. Tokyo is the capital and the Greater Tokyo Area is the most populous
metropolitan area in the world [1].

Flag

COUNTRY
DEMOGRAPHICS
Total population as of 2019
Projected population as of 2050
Percent of population under age 15
Percent of population ages 65 and older

Coat of arms

126,200,000
109,900,000
12%
28% [2]

COUNTRY HEALTHSTATISTICS
Life expectancy at birth females/males
Birth per 1,000 population
Deaths per 1,000 population
Infant mortality rate per 1,000 live births
Maternal mortality rate per 100,000 live births

87 / 81
711
2 [2]
5 [3]

HEALTH CARE SYSTEM
1. Please describe briefly your country’s health care system model
public/private/nonprofit mix; type of primary health care facilities and hospitals.

includingJapan has a statutory health insurance system that is financed through general tax revenue andinsurance premiums. Citizens can obtain also private insurance that covers care in private facilities andthe cost of copayments. The out-of-pocket expenses differ and are lower for citizens with low incomes,
the elderly and children [1].
2. Please describe briefly the financing of health care including Gross Domestic Product (GDP)per capita, percentage of GDP spent on health care, and the proportion allocated to primary
health care.
In 2016, GDP per capita in Japan was estimated at US$38,794.3, out of which 10.93% was spent onhealth care. In total, Japan spent US$4,233.03 per person on health care in 2016 [4].
In Japan, there is no epidemiological survey specialized in primary health care.
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CANCER CARE
1. Please provide key statistics in relation to risk factors (alcohol, smoking, diet, obesity rates,
physical activity) and main causes of death.
Alcohol per capita
Smoking prevalence
DietPrevalence of overweight andobesity
Physical activity

7.2 in litres of pure alcohol in 15+ years population in 2017 [5]17.7% of persons aged 15+ in 2017 [6]In 2013, calorie supply per capita was 3276 kcal per day.
Supply of fat and protein were 150.9g and 106.3g per capita
per day [7]
In 2017, the overweight rate was 21.6% and obesity rate was
4.4% of population aged 15+ [8]Prevalence of insufficient physical activity among adults aged
over 18 years, was 35.5% in 2016 [9].

The top five leading causes of death in Japan in 2017 were malignant nesplasms, heart diseases,
cerebrovascular diseases, senility without mention of psychosis, and pneumonia [10].

2. Please provide key cancer related data (incidence, survival, mortality for major cancers)
There were 883,395 new cases of cancer diagnosed in Japan in 2018. The number of new cancer cases
was higher for males than females (504,648 and 378,747 respectively). The top five most frequent
incidences of cancer in 2018 are presented by sex below [11]:Incidence of cancer - males
Cancer type
Cases % in total
Colorectum
82,641 16.4
Lung79,431 15.7
Stomach76,899 15.2
Prostate
70,654 14
Bladder
28,922 5.7

Incidence of cancer - females
Cancer type
Cases% in total
Breast66,101
17.5
Colorectum
65,51017.3
Lung39,54010.4
Stomach38,647
10.2
Pancreas
21,4995.7

In 2018, there were 409,399 cancer-related deaths with a higher number of male to female deaths(235,625 and 173,774 respectively). The top five most frequent cancer-related deaths in 2018 were: lungcancer (81,820 deaths – 20%), stomach cancer (48,535 deaths – 11.9%), colon cancer (40,580 – 9.9%),
pancreas cancer (37,358 – 9.1%), and liver cancer (28,986 – 7.1%) [11].
In 2018, the 5-year prevalence of all cancers for all ages was 2,127,559 survivors, with a higher numberof males than females (1,149,228 and 978,331 respectively) [11].

3. Please describe briefly key elements of the health system for cancer prevention, early
diagnosis and screening, treatment, and palliative care.

Cancer has been the leading cause of death in Japan. The Cancer Control Act was enforced in2007 and the Basic Plan to promote Cancer Control Programs was made in the same year.
The basic concepts of the law are as follows.
① Promotion of cancer research and utilization of research outcomes② Equalization of cancer medical services③ Development of cancer medical services to satisfy patients
Based on this law, the Japanese government built the Basic Plan to promote Cancer Control
Programs. This plan must reflect the opinion of cancer patients and their families, as well as cancer
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medical specialists and academic experts. Each prefecture is expected to build the Prefectural Planto Promote Cancer Control modeling the national basic plan. The national government, localcommunities, medical insurance systems, physicians and surgeons will support each other torealize the above 3 basic concepts [12].
In accordance with the Plan, all municipalities have carried out quality control and evaluation ofcancer screening, conducted cancer screening based on scientific evidence, and tried to improve
the screening rate to 50% within 5 years.
In addition, training of staff specialized in cancer medical care has been promoted, and thefunction of core hospitals for cancer treatment has been enhanced, so that collaborative cancer
treatment and quality of palliative care could be improved.
4. Please provide a brief description of major health promotion activities including national healtheducation campaigns and services, including a description of cancer control health promotion
activities, and the involvement of nurses.

Promotion of prevention/early discovery of cancer and equalization of cancer medical services havebeen implemented based on the “Basic Plan to promote Cancer Control Programs [13]．
① Promotion of cancer prevention and dissemination/enlightenment
 Dissemination/enlightenment related expenses
Creation of brochures, etc, by Center for Cancer Control and Information Service
Promotion of cancer screening through cooperation with enterprises
Health support measure for females

 Research on emergency measures to overcome hepatitis, etc② Establishment of consultation support and information provision systems for cancer medicalcare Improved information provision and support projects by Center for Cancer Control andInformation Services③ Promoting cancer education for children
The Ministry of Education, Culture, Sports, Science and Technology and the Ministry ofHealth, Labor and Welfare have begun preparations to develop cancer education forchildren to learn the importance of health and life and to have correct knowledge aboutcancer.
Nurse specialists in cancer have been working in the areas of cancer prevention,chemotherapy/radiation therapy, and palliative care in order to improve patients’ quality of life.

NURSING WORKFORCE ANDEDUCATION3

1. Number of registered nurses working in cancer control

There are 833 Certified Nurse Specialists specialized in oncology nursing (2019), 2454 Certifiednurses (CNs) in Palliative care, 1646 CNs in Cancer Chemotherapy Nursing, 773 CNs in Cancer PainManagement Nursing, 372 CNs in Breast Cancer Nursing, 323 CNs in Radiation Therapy Nursing(2019) [14]. (in 2019, Cncer Pain Management Nursing Program integrated to Palliative care)
2. Qualifications, roles, and scope of practice for nurses working in cancer control

Qualifications
Certified Nurse Specialists in Cancer
Nursing

Roles and scope of practice
Understand the physical and mental distress of cancer
patients and provide high quality nursing care topatients and their families from the viewpoint ofquality of life (QOL).

Certified Nurse in Palliative Care

Relieves painful symptoms such as pain, dyspnea,
general malaise, and edema.
Care for loss and grief to patients and families.

Certified Nurse in Cancer
Chemotherapy

Safe handling and appropriate administration ofcancer chemotherapeutic drugs
Relieve side effects and support self-care

Certified Nurse in Breast Cancer
Nursing

Supporting self-care and self-determination forpatients receiving multidisciplinary treatment
Support for psychological and social problems bychanging body image

Certified Nurse in Radiation Therapy
Nursing

Self-care support
Providing a safe and comfortable treatment
environment[14]
3. Higher education institutions (HEIs) including university departments and faculties, colleges, andother public or private institutions that offer programs leading to a recognised nursing qualificationin cancer control.

There are 79 Master programs for Advance Practice Nurse that is certified by Japan Association of
Nursing Program in Universities (JANPU) [15]. Japan Nuring Association and some College ofNursing also provide the Program for Cirtified Nurse (19 ereas including 4 oncology nursing ereas.
Those are 6 months program).

OTHER NURSING ISSUES
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1. Provide a brief description of credentialing/accreditation systems for nurses working incancer control.

Certified Nurse Specialists in Cancer Nursing
In order to become Certified Nurse Specialists in Cancer Nursing, it is required to complete
a master's program at a nursing graduate school, and after at least 5 years of practicaltraining, it is also essential to be certified by the Japan Nursing Association.
Certified Nurses in the area of oncology
In order to become a certified nurse, it is necessary to pass a certification examination
conducted by the Japan Nursing Association after completing a 6-month training course. It
is also needed to practice at least 5 years of practical training. [14]2. Provide a brief description of cancer nursing professional organisations, e.g.
membership; objectives; key functions; role in policy-making.

The Japanese Society of Cancer Nursing was established in 1987, and since then, the society
has been promoting the development and improvement of research and education regarding
cancer nursing and contributes to the health and welfare of people. In order to fulfill its
purposes, the society has been conducting the following activities:(1) Convene an Academic Conference(2) Publish official Journals(3) Improve practices in each nursing specialty and facilitate research and education activities(4) Cooperate and link with relevant national and international academic societies(5) Conduct international exchange activities(6) Conduct social activities to contribute to people’s health and welfare(7) Conduct other activities deemed necessary to achieve the Society’s purpose [16]3. Provide a brief description of continuing education training and structure for nurses
working in cancer control, including necessary requirements for licensing/revalidation;access to continuing education, and sources of funding.

Both Certified Nurse Specialists and Certified Nurses in the area of oncology must undergo arenewal assessment every five years after acquisition is required to maintain the level ofpractice. [14]4. Provide a brief description of nursing leadership positions and roles, e.g. at ministry,district, local and hospital levels; role in cancer policy-making; management of nursing
services; in higher education and research institutions; in regulatory bodies; in national
professional associations and trade unions; in nongovernmental organizations.

The Cancer Control Act promoted multidisciplinary team approach and the development oftraining for professionals including nurses. The Act also recommended that core cancer
treatment hospitals should have trained nurse specialists like Certified Nurse Specialists andCertified nurses, so that they could support cancer patients and their family throughout thecancer treatment [17].
The Japan Society of Cancer Nursing started a “High-quality nurse training program inspecialized areas (cancer / diabetes)” by the Ministry of Health, Labor and Welfare as part of theproject in 2006. The Society developed a new training program for nurses in oncology area, sothat the project could be conducted effectively in each region, thereby contributing to improving
the quality of cancer nursing practice [16] .

5REFERENCES
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Cancer Control Measures https://www.mhlw.go.jp/english/wp/wphw5/dl/23010222e.pdf
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Japanese Society of Cancer Nursing http://jscn.or.jp/rule/index.html
Overview of Cancer Control Act https://www.mhlw.go.jp/english/wp/wphw4/dl/health_and_medical_services/P73.pdf

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