• 6/10/2005
  • Japan
  • Tomoya Aie, Yuki Takaymana, Msahiko Idegawa
  • The Asai Shimbun (www.asahi.com)

As if undergoing cancer treatment isn’t harrowing enough, some patients find that where they live can cost them dearly. Just getting to a qualified care center can add frequent long-distance travels to their life, not to mention tens of thousands of yen to their monthly budget.

A 33-year-old cancer patient in Kochi Prefecture has to travel more than 1,500 kilometers to and from Tokyo almost every week for chemotherapy.

A 63-year-old Tokyo resident who needed radiation therapy for his tongue cancer had to fly to Sapporo five years ago to get treatment.

“We are like refugees desperately searching for a doctor to rescue us,” said a participant at the first national convention of cancer patients in Osaka in May.

About 2,000 people, including patients and their relatives, took part in the meeting, which called for improved treatment levels across Japan. It was organized by 23 patients groups.

Even a panel of the Ministry of Health, Labor and Welfare acknowledges a glaring disparity among regions in the quality of cancer treatment. It says there is a gap of up to 10 percentage points in the five-year survival rates for cancers of the stomach, large intestine and lung among six prefectures, including Osaka and Yamagata, that it studied.

No simple nationwide comparison is possible because of a lack of long-term statistics on incidences of cancer and survival rates. But a separate survey of 30 cancer hospitals nationwide recently found gaps of up to 13 to 20 percentage points for cancers of the stomach, lung and breast.

To Tomoko Ogura, a company employee in Kochi, that fact hit home when she underwent an operation for stomach cancer in a large public hospital in Kochi Prefecture in early 2004.

Soon after having her stomach and gall bladder surgically removed, Ogura, 33, found that her cancer was in a much more progressed stage than she had been told. Her doctor, who had tried to shield her from the truth so as “not to discourage her,” was not comfortable about recommending chemotherapy to prevent a recurrence. She couldn’t find another local specialist to consult for a second opinion.

She decided to commute long-distance to Tokyo to receive chemotherapy. Accompanied by her husband, she began her monthly visits to a Tokyo hospital last November. When a new cancer was detected in March, her chemotherapy cycle and her visits became almost weekly. The transportation and other costs come to more than 200,000 yen each month.

“I used to think we could receive treatment that suits us at any hospital,” said Ogura, who attended the Osaka event on her way home from Tokyo. “This attitude of patients-leaving everything to their doctors-may be a factor in delaying progress in medical treatment.”

Besides starting her own Web site to share her experiences, she also joined forces with other patients to lobby local assembly and Diet members.

Their petition has prompted the Kochi prefectural assembly to adopt a resolution calling for more trained chemotherapy specialists.

Shoichiro Aida, of Kunitachi, western Tokyo, told the Osaka meeting how cancer patients are trying to seek treatment information. Aida, 63, was diagnosed as having cancer of the tongue five years ago.

The doctors at the hospital who gave the diagnosis suggested he undergo external radiation treatment, combined with chemotherapy. That would have required three to six months of hospitalization.

As an official at the National Consumer Affairs Center of Japan, busy dealing with the problems consumers face, Aida felt it was “wrong to leave an issue concerning one’s life totally to doctors.”

Aida researched tongue cancer treatment on his own until he came across what is known as brachytherapy, which uses a needle to concentrate radiation on the tumor. He chose what is now the National Hospital Organization Hokkaido Cancer Center in Sapporo, where internal radiation specialists had achieved considerable success.

His cancer was at an advanced stage, but with brachytherapy, he was released after three weeks of treatment. He is now tested every three months.

In January 2004, Aida set up a cancer-treatment help group with Masamichi Nishio, a doctor at the Hokkaido Cancer Center, and others.

These problems mostly come from the fact that only about 1,000 physicians are administering chemotherapy in Japan, according to Yuichiro Ohe of the National Cancer Center Hospital in Tokyo. He also serves as director of the Japan Society of Medical Oncology. That figure pales next to the 9,000 chemotherapy specialists in the United States, which has twice the population of Japan.

Advances in computerized equipment have expanded the possibilities of radiotherapy, which in turn has fueled demand for specialists in that field as well. But compared with the United States, Japan has only one-fifth the number of radiotherapy doctors per 1 million people, according to Yutaka Hirokawa, a professor of radiotherapy at Juntendo University School of Medicine.

The ratio of radiotherapy technicians is one-third that of the United States. The ratio of medical physics engineers who are capable of maintaining radiotherapy equipment and ensuring its precision remains a mere one-thirtieth, he said.

Under the current 10-year anti-cancer program, the government aims to raise the five-year survival ratios by 20 percentage points by 2014. Officials say the greatest challenge is to rectify regional gaps.

The health ministry panel in April called for starting programs to train specialists in chemotherapy and radiotherapy at national cancer centers and university hospitals