Based on recommendations from several agencies, including the European Society for Medical Oncology, palliative care (PC) services are increasingly recognised as an essential part of oncology care. However, the implementation of integration of oncology and palliative care (IOP) seems to be evolving slowly and detailed progress of IOP remain unclear. This was a cross-sectional nationwide survey to clarify the current status of IOP in Japan.
We performed comparison between designated cancer hospitals (DCHs) and non-designated cancer hospitals (non-DCHs), since considerable number of patients in Japan are receiving cancer treatment at non-DCHs. We distributed the questionnaire to executives or directors of oncology departments at cancer hospitals in November 2017 and sent a reminder mail later. Our questionnaire was developed based on indicators of IOP with international consensus. We conducted descriptive statistics, t-tests and Cochrane-Armitage trend tests where appropriate. To adjust the difference of inpatient beds scale, estimates at non-DCHs were weighted by the distribution of inpatient beds at DCHs.
Among the 399 DCHs and 478 non-DCHs that were surveyed, 269 (67%) and 259 (54%) responded, respectively. DCHs had significantly more PC resources than non-DCHs did (e.g. both full-time physicians and nurses on a PC team, 53% vs. 14% (p < 0.001); the availability of outpatient PC service ≥ 3days per week, 48% vs. 21% (p < 0.001)). Clinical tools for PC services were well equipped (e.g. symptom management guidelines, 89% vs. 79% (p = 0.238); PC referral criteria, 72% vs. 59% (p = 0.077)). However, strategies to identify suitable patients for PC referral seemed to be undeveloped (e.g. clinical care pathways, 17% vs. 5% (p < 0.001); referral using time trigger, 9% vs 8% (p = 0.358); referral using needs trigger, 31% vs. 20% (p = 0.820)). Mutual rotation training for both oncology and PC fellows and research opportunities on IOP were limited.
Non-DCHs face a severe lack of PC resources, whereas DCHs might have relatively more resources to enhance IOP. Both education and research opportunities for IOP were limited. Further research is warranted to identify specific barriers to and facilitators for implementation of IOP.
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Graduate School of Medicine, Kyoto University.
Ministry of Health Labor and Welfare in Japan (Health Labor Science Research Grant).
All authors have declared no conflicts of interest.