Kaori Yagasaki: Supporting the Lives of Patients Living with Cancer—From the Perspective of Cancer Nursing

2025/07/07

Since 1981, cancer has been the leading cause of death in Japan. In recent years, the cancer incidence rate has risen, with estimates suggesting that approximately one in two people will be diagnosed with cancer in their lifetime. Although various cancer control measures have been promoted, cancer remains a significant threat to people's lives and health. This article will discuss cancer control measures, as well as the nursing and team-based medical care that support patients and families living with cancer in society.

A major transformation in Japan's cancer control measures was the enactment of the Cancer Control Act on June 23, 2006 (Act No. 98). A key challenge was to ensure that cancer patients (including former patients) could receive comprehensive support tailored to their circumstances. To further enhance these measures, the act established basic principles, clarified the responsibilities of the national government, local governments, medical insurers, the public, physicians, and employers, and mandated the formulation of plans to promote cancer control and other fundamental matters.

The goal of achieving standardization of cancer care was set to ensure that all patients and their families can receive cancer care—including prevention and early detection—without regional disparities. Various cancer control plans have been formulated, leading to accelerated changes in cancer-related research, education, and practice. Concurrently, rapid advancements in cancer-related drug discovery and medical care have expanded the possibilities for patients to lead social lives while undergoing treatment. Supporting the social lives of patients living with cancer has become a critical issue.

As part of the infrastructure development under the Basic Plan to Promote Cancer Control Programs, "strengthening human resource development" was promoted, leading to the launch of the MEXT-subsidized Cancer Professional Training Plan in 2007. This project aims to train medical professionals capable of handling the future sophistication of cancer care. Seventy-six national, public, and private universities with graduate schools of medicine and their affiliated medical institutions across Japan develop, implement, and share outstanding educational programs through inter-university collaboration. To date, three five-year project phases have been completed. The current fourth phase (from fiscal year 2023), the Next-Generation Cancer Professional Training Plan, is training personnel to address emerging challenges in the field of cancer care. The initiative has also expanded beyond graduate education to include the training of researchers and a wide range of personnel involved in community collaboration, while also emphasizing the development of patient- and citizen-participatory cancer care, rather than a provider-centric approach.

At our university, the Graduate School of Medicine, the Graduate School of Health Management (Nursing major), and the Graduate School of Pharmaceutical Sciences collaborate. We have been selected for the "Gan-Pro" (Cancer Professional) project from its first through fourth phases, and have established and promoted various courses to train experts who will lead advanced cancer care. A key strength of our university is our ability to promote highly specialized practice, education, and research, as well as collaboration and cooperation among these graduate schools.

In the Nursing major of the Graduate School of Health Management, we train nursing practitioners, educators, and researchers to lead advanced cancer care through our master's and Ph.D. programs. The master's program includes a Certified Nurse Specialist (CNS) education course, which trains CNSs not only in cancer nursing but also in diverse fields such as psychiatric, genetic, and geriatric nursing.

A Certified Nurse Specialist (CNS) is a nurse recognized for outstanding practice abilities, having acquired advanced knowledge and skills in a specific nursing field through a master's program and subsequently passed the CNS certification examination. They are expected to efficiently provide high-level nursing care to individuals, families, and groups with complex and difficult-to-solve nursing problems. In particular, Certified Nurse Specialists in Cancer Nursing play a role in understanding the holistic suffering of cancer patients and providing high-level nursing care to them and their families from a Quality of Life (QOL) perspective. However, the number of nurses in Japan with this certification remains low, at 1,133 (as of December 2024). From the viewpoint of standardizing cancer care, we aim to further strengthen the training of these specialists.

Although cancer control measures have been strengthened, a multitude of challenges remain from the patient's perspective. Are the needs of individual patients and their families being met? Are they convinced by, reassured by, and satisfied with their treatment and care?

In recent years, advances in cancer care and drug discovery, along with methods to alleviate side effects, have made it possible for patients to live in society while undergoing cancer treatment. However, while new drugs and therapies offer benefits, patients also experience new side effects and long-term sequelae that can interfere with daily life and reduce their QOL. These physical symptoms can lead to issues with work, family, finances, and interpersonal relationships, affecting their entire way of life. For instance, patients may face social challenges, saying things like, "I have lingering numbness and weakness in my hands and feet after chemotherapy, and I'm not sure when I can return to work," or "I can't take on a high-responsibility job because I don't know when my condition might worsen." I also hear that skin disorders caused by cancer drug side effects (such as pigmentation, acneiform rash, and hand-foot syndrome) are sometimes perceived by others as "skin diseases," leading to prejudice and misunderstanding. The accumulation of these experiences can erode a person's self-esteem.

Furthermore, patients may have to live with functional changes, losses, and long-term effects, such as an artificial anus created for colorectal cancer treatment or the loss of voice following surgery around the vocal cords for laryngeal or pharyngeal cancer. In other words, the end of cancer treatment does not mean the end of suffering and burdens. We must understand that people who have experienced cancer continue to face and cope with various challenges in society.

A crucial role for nurses is to provide support to alleviate this multifaceted, holistic suffering. By taking a comprehensive view of patients' lives, nurses offer individualized care to improve their QOL while they live with cancer. In particularly complex and challenging situations, Certified Nurse Specialists in Cancer Nursing are expected to apply more advanced practices to find paths to resolution and drive improvement.

Furthermore, a single profession, whether doctors or nurses alone, has limitations in addressing the diverse suffering of cancer patients. It is beneficial to function as a team, collaborating with multiple professions (such as nurses, doctors, pharmacists, dietitians, physical therapists, and social workers) to leverage each specialist's expertise in solving complex problems. In recent years, the term "team-based medical care" has become common, and some medical reimbursement schemes even include additional payments for having designated professional staff. In cancer care, various multidisciplinary teams—such as palliative care teams, pain management teams, nutrition support teams, and community liaison/discharge support teams—operate across departments within facilities, though their names may differ. Within these teams, Certified Nurse Specialists in Cancer Nursing contribute to the smooth delivery of collaborative care. They act as coordinators—and sometimes leaders—who connect patients with multidisciplinary professionals and bridge gaps between the professionals themselves, all while maintaining a neutral stance that respects the patient's wishes and values.

After active treatment ends and the follow-up period begins, the frequency of outpatient visits decreases, and patients have less contact with healthcare providers. To prevent patients and their families from feeling lost or isolated about whom to consult regarding cancer-related anxiety, recuperation, work, school, or daily life problems, cancer counseling and support centers have recently been established in "Designated Cancer Hospitals," "pediatric cancer centers," and "regional cancer clinics" nationwide. Although the names may vary by facility, anyone can consult on various cancer-related matters at any time, regardless of their diagnosis or treatment status. These centers provide continuous support and opportunities for people to discuss questions and concerns about all aspects of life, including recuperation and returning to society. The number of facilities offering specialized nursing outpatient services, such as for stoma care and cancer pain management, or providing nursing consultations for visiting patients, is also increasing. Additionally, specialized cancer hospitals have established telephone consultation services accessible to everyone.

The challenges faced by people living with cancer are unique to each individual. Nurses strive to provide support from the patient's perspective, helping them move even one step closer to a solution. We must continue to develop and improve systems to ensure that people leading social lives with cancer do not become isolated, can make full use of social support systems, and can easily access appropriate information.

In addition, to help cancer patients lead their social lives with peace of mind, we should provide ongoing education and awareness about the basics of cancer, its treatments, and side effects to people of all ages, from children to the elderly, regardless of their own cancer status. This will help patients gain understanding from their communities and society, making it easier for them to receive support. Moreover, if individuals are diagnosed with cancer themselves, having some prior knowledge may expand their repertoire of coping strategies.

Cancer is not just an individual problem; it is a challenge for society as a whole. To improve the quality of cancer care, training medical professionals as described earlier is essential. By having multidisciplinary professionals acquire specialized knowledge and skills, engage in continuous self-improvement, and provide high-quality medical care, we can expand the life possibilities for cancer patients and make their lives richer. We aim to contribute to the development of a society where patients and their families can live with peace of mind.