Symposium 2:
The Future for Palliative Oncology
2-5 Additional Comment

Palliative Oncology：
Elimination of inconsistencies in palliative care andclinical oncology
Higashi Sapporo Hospital
Takeshi TERUI, MD. PhD

SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Facts regarding Higashi Sapporo Hospital
Government-certified cancer hospitalFounded in 1983 by Dr. Kunihiko Ishitani for the treatmentof advanced, recurrent and terminal cancer patients.
243 inpatient beds (58 for palliative care)
Outpatient and at-home services
100-bed Nursing home attached
85% of inpatients suffer cancer, with 50% receiving palliative
care in combination with anti-cancer therapy
Approx. 800 cancer-related deaths per year: 15-20% of totalcancer-related deaths in Sapporo
SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Brief chronology of Higashi Sapporo Hospital（focus on international relationships)
・1987 Established a sister relationship with Calvary Hospital (NY).
・1990 4th Sapporo Winter Cancer Seminar on “Cancer and QOL”
with Dr. William Breitbart and Dr. Frank Brescia.
・1993 Hawaii Conference: Cancer Care in the 1990’s: Supportive CareIssues. Jointly organized by Memorial Sloan-Kettering Cancer Center,Calvary Hospital, and Higashi Sapporo Hospital.
・1996 1st Congress of the Japanese Society for Palliative Medicine
with Dr. Russell Portenoy.
・1997 1st Annual Meeting of Hokkaido Palliative Medicine with Dr. Eduardo Bruera.
・2008 14th Meeting of the Japanese Society for Clinical Thanatology
with Dr. Frank Brescia
・2014 1st Sapporo Conference for Palliative and Supportive Care in Cancer
・2016 Dr Friedrich Stiefel spent a 6-month sabbatical at HSH.
Education & research agreement signed with Thailand, Bureau ofSCPSC2017 第二回がん緩和ケアに関する国際会議
Technical and Academic Affairs, Departmentof Medical services.
・2017 2nd Sapporo Conference for Palliative and Supportive Care in Cancer
SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCERASCO (American Society of Clinical Oncology)
Statements on Palliative Care
1. American Society of Clinical Oncology Provisional
Clinical Opinion: The Integration of Palliative Care Into
Standard Oncology. Smith TJ, Temin S, Alesi ER et al. JClin. Oncol. 30:880-887, 2012
2. Integration pf palliative care into standard oncology
care: American society of clinical oncology clinicalpractice guideline update. Ferrell BR, Temel JS, Temin Set al. J. Clin. Oncol., 35(1), 96-112,2017
SCPSC2017 第二回がん緩和ケアに関する国際会議

SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCERCan symptoms be considered as a result of the“Tumor-host relationship”?
1. The idea of ASCO’s cancer-related complications
2. Paraneoplastic syndromes
3. Cachexia and cytokines
4. Tumor fever and cytokines

5. Thiamine deficiency and delerium
6. Breakthrough cancer pain (?)
In the future,・cancer-immunology
・exosome
SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Quality of palliative cancer care and CDS (continuousdeep sedation)
Of 1581 patients who died in the PCU between April
2005 and August 2011, only 22 (1.39%) were treatedwith CDS.
Further, no patients at HSH have received CDS since
September 2011.
Effectiveness of multidisciplinary team conference on
decision-making surrounding the application ofcontinuous deep sedation for terminally ill cancerpatients.
Koike K, Terui T, et al. Palliat Support Care. 2015
Apr;13(2)157-64
SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Current situation regarding clinical oncologists andpalliative care specialists
There is a general shortage of palliative care specialists
so that the concept of “integrated” oncologic/palliative
treatment cannot actually be implemented at present.
Total no. of cancer patients in Japan 3-5 million（Est.)

Clinical oncologists:
Society for Clinical Oncology 17,664
Society of Medical Oncology
8,392
Society of Hematology
7,200（Certified cancer doctors 14,834）
Society for Palliative Medicine
5,902
SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Some cancer patients referred for palliative carerequire chemotherapy.
2% of patients referred to HSH for palliative care also require
chemotherapy, with 20% of these patients receiving standard
chemotherapy with a mean survival of over 15.5 months.

Recovery of cancer patients’ social lives upon referral to palliative
care units. Terui K., Ishitani K., et al.
(Palliative Care in oncology symposium 2016 Sep.9-10, San Francisco, USA)SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Results for cancer patients referred for to Higashi Sapporo
Hospital for palliative care

3 years (2013-2016)

Pre-referral therapy

No therapy

No. cases referred to PCU
595
No. cases receiving CTx
5 (0.84%)
after referral to PCU
Reason for decision by previous
physician (Multiple factors)
Diagnostic issue
3
Response toCTx
1
Lack of supportive care
3
Actual no. cases receiving CTx
5/5
Mean survival (months)
Average did notreach 15.5monthsreceiving CTx

2nd-line CTx

Total

940

1535

26 (2.77%)

31 (2.02%)

1761320
7
15

18/26

23/31

4.9

6.1

SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER

Extract from statement by ASCO in 1998 afterparticipation in “Project on Death in America”
Cancer Care During the Last Phase of LifeASCO believes that it is the oncologists’ responsibility to care for
their patients in a continuum that extends from the moment ofdiagnosis throughout the course of the illness. In addition toappropriate anticancer treatment, this includes symptom control
and psychosocial support during all phases of care, including
those during the last phase of life.
by Dr Robert J. Mayer et al (J. Clin. Oncol. 16:5, 1986-1996, 1998)

SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCERConcluding remarks

We believe that instead of the “integration” of clinicaloncology and palliative care, the concept of more aggressive“palliative oncology,” with an understanding of psychooncology in which clinical oncologists play a central role, is amore appropriate approach.

SCPSC2017: 2ND SAPPORO CONFERENCE FOR PALLIATIVE AND SUPPORTIVE CARE IN CANCER