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CANCER SURVIVORSHIP COUNTRY PROFILE JAPANcancersurvivorship.eiu.com/wp-content/uploads/sites/36/2017/07/Japan.pdf · CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN to be higher. With cancer

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Page 1: CANCER SURVIVORSHIP COUNTRY PROFILE JAPANcancersurvivorship.eiu.com/wp-content/uploads/sites/36/2017/07/Japan.pdf · CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN to be higher. With cancer

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CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN

Although Japan has a very large number of cancer survivors relative to total national population, surprisingly little information is available on the experiences and challenges faced by Japanese people living with and beyond cancer.1 The healthcare system in Japan produces some of the best outcomes in the world, and universal access to health insurance is entrenched. Given that cancer has been the leading cause of death for decades, it is perhaps not surprising that policies addressing it have been in place far longer than in many other high-income countries.

CANCER SURVIVORSHIP IN JAPANThe most commonly occurring cancers in Japan are those located in the breast, colorectum (large bowel), prostate, stomach and lung (see Figure 1). These five cancers accounted for 60.7% of all new cancer diagnoses in Japan in 2012.2 Survival rates vary by type of cancer and have improved since the 1990s for all of the most common cancers—most significantly for prostate cancer, for which the five-year age-standardised survival rate rose from 65.7% in 1995-99 to 86.8% in 2005-09. In 2012 Japan had the world’s second-highest age-standardised five-year survival rate for lung cancer (after Mauritius, which, however, had only a small number of cases) (see Figure 2).3

In Japan, an estimated 26.3% of men and 17.6% of women will develop cancer before the age of 75.4 The number of survivors has been increasing steadily—including for patients with breast and prostate cancer, two of the most common cancers—against the backdrop of medical advances and high incidence among people of working age (see Figure 3). In total, more than 2m adults—around 1.7% of the population of 127m—had survived cancer for five years in 2012; of these, 19.2% had been diagnosed with colorectal cancer, 16.5% with stomach cancer and 12.3% with breast cancer (see Figure 4).5

HEALTHCARE SYSTEM CONTEXTJapan has a strong tradition of universal health coverage. The first national policy for health insurance dates back to 1923.6 Universal access—known as kaihoken—was introduced in 1961.7 The system comprises a single national benefits package and a single fee schedule set by the government.8 This underpins cost-effectiveness and equitable distribution of healthcare, which has been further enhanced by adjusting co-payment policies that apply to different types of insurance programmes. There are over 3,500 insurance plans in Japan, which fall into specific

© The Economist Intelligence Unit Limited 2017 1

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CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN

categories, with municipal schemes covering people who are retired, self-employed and unemployed, and employer-employee schemes covering salaried workers. Consumers are thus assigned to a specific scheme, with cost-effectiveness achieved through regulation rather than competition.9 Premiums vary from one plan to another.10 Co-payments also vary, typically between 10% and 30%, and are capped at around US$800 in any given year, according to Miyako Takahashi, head of the survivorship division at the National Cancer Centre (NCC); there are waivers for young children and low-income households.11 The fragmentation seen in health insurance is reflected in service provision: for example, there are more than 8,500 hospitals.

Despite this fragmentation, health outcomes in Japan are among the best in the world. For example, Japanese women have had the highest life expectancy in the world since 1986, reaching 87 years in 2014, and life expectancy in men has been more than 80 since 2013. However, this longevity, combined with a declining birth rate, is creating significant pressure in the

Source: International Agency for Research on Cancer (IARC), GLOBOCAN 2012: Estimated Cancer Incidence,Mortality and Prevalence Worldwide in 2012.

Age-standardised incidence and mortality for both sexes per 100,000 people bycancer site in Japan, 2012(per 100,000 people)

Figure 1

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3© The Economist Intelligence Unit Limited 2017

CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN

system. The government is addressing the country’s demographic and epidemiological changes through radical reform.12 Reforms began in 2000 with the introduction of mandatory long-term care insurance for older people, known as kaigo hoken, run by municipalities and funded through central government contributions and an additional 1-2% income tax payable by people aged 40 and older.13 In 2008, a new health insurance programme was introduced for people aged over 75.14 In the same year, financial incentives were introduced to overcome poor collaboration

Source: C Allemani et al, 2015, “Global surveillance of cancer survival 1995–2009: analysis of individual data for25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)”, The Lancet, Volume 385,Issue 9972, 977-1010, March 2015. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25467588.

Net survival for both sexes for common cancers in Japan(Five-year age-standardised net survival, %)

Figure 2

Breast Prostate Colon Rectum Lung

1995-99 2005-092000-04

81.8 84.2 84.7

65.7

83.4 86.8

61.4 62.2 64.456.6 57.8 60.3

22.9 28.5 30.1

Stomach

51.7 53.6 54.0

Source: Global Burden of Disease Study 2015 (GBD 2015) Results. Seattle, United States: Institute for Health Metrics andEvaluation (IHME), 2016. Available from http://ghdx.healthdata.org/gbd-results-tool.

Cancer incidence and mortality in Japan, 2015(no. of people)

Figure 3

15-69 years

70+ years

Incidence in womenMortality in women

Incidence in menMortality in men

404,269 167,935

207,110

261,143

43,848

127,129

271,990 76,590

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CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN

between primary-care doctors and specialists in tertiary care, aimed in particular at improving care co-ordination for cancer, stroke, cardiac and palliative care.15

PUBLIC POLICY ON CANCER SURVIVORSHIPJapan implemented its first Comprehensive 10-Year Strategy for Cancer Control in 1984, and this was followed by two further ten-year strategies. The 2006 Cancer Control Act introduced more frequent planning through Basic Plans to Promote Cancer Control that must be updated every five years. The first of these plans was approved by the Japanese Diet (parliament) in

2007 and the second in 2012.16

The 2007 Basic Plan required that all government-designated cancer centres develop integrated care pathways for cancer patients with the major types of cancer to improve collaboration between cancer specialists and community doctors during treatment and in the follow-up phase. The second Basic Plan expanded its focus to the broader social context, aiming to mitigate difficulties in returning to work or education and provide cancer survivors and their relatives with better support. It also emphasised the need to develop public awareness of issues around cancer survival.17 In another positive development, the NCC established a Division of Cancer Survivorship Research in 2013.18

Although there is no cancer-specific social-welfare system in Japan, existing benefits could be used more effectively. These benefits include refunds for major medical expenses, income protection and tax deductions for medical expenses. Part of the policy response is, therefore, to ensure that cancer patients are made aware of these as soon as possible after their diagnosis.19

CHALLENGES FACED BY CANCER SURVIVORS IN JAPAN20

Japan has a very large number of cancer survivors. One study put the total at 5.3m people (including adults and children who have survived cancer for more than five years) at the end of 2015, although the NCC is not confident of the accuracy of this figure and believes the number

Figure 4Five-year survival for cancer inJapan, 2012(%)

Source: IARC, GLOBOCAN 2012: Estimated CancerIncidence, Mortality and Prevalence Worldwide in 2012.

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3.9%3.8% 16.5%

19.2%

12.3%

24.5%

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CANCER SURVIVORSHIP COUNTRY PROFILE JAPAN

to be higher. With cancer survivors thus making up more than 4% of the population according to this definition, Japan’s cancer policy has a clear focus on improving survivors’ quality of life and ensuring that they can resume normal life as far as possible.21 Survivorship research is very limited, although this has been improving as a result of the establishment in 2013 of a dedicated cancer survivorship research division within the NCC.22 According to Dr Takahashi, there is still some stigma attached to the perception of cancer in parts of Japanese society; removing it will greatly improve the landscape for survivors. The most powerful remedy in this regard is improving cancer “literacy”, adds Dr Takahashi.

Until recently, cancer survivors in Japan lacked information about what to expect once the acute treatment phase has ended. Some report that it can also take a long time to get reimbursed for medical expenses,23 although delays are not believed to be standard, says Dr Takahashi. Social alienation and difficulty with employment are also cited as challenges.24

According to Dr Takahashi, the NCC has implemented several measures to help to address the information challenge, including a guide for cancer survivors, case studies of survivors, and tweaks to legislation that spell out employers’ obligation to support cancer patients through treatment and beyond. The national school curriculum has also incorporated cancer awareness, and efforts have been made to educate the general public through advertisements and community-based activities and lecture series.25 The NCC also hosts an online cancer information portal, says Dr Takahashi.

In addition to these activities, there are several survivors’ support groups, such as Maggie’s Tokyo, that include dietary and exercise programmes, patient meetings and mental healthcare sessions, Dr Takahashi points out.

CONCLUSIONJapan’s long history of cancer as a major contributor to the country’s disease burden, coupled with its highly efficient healthcare system and commitment to equitable access to healthcare, create a relatively strong framework for the country’s cancer survivors. There is still some stigma attached to the perception of cancer in parts of Japanese society. Encouragingly, though, Japanese cancer-control policy is comprehensive, and the NCC has implemented several measures to help to improve the dissemination of information on cancer survivorship.

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1. For a portrait of global cancer survivorship see The Economist Intelligence Unit, Cancer survivor-ship: a portrait. Available at: http://cancersurvivorship.eiu.com/cancer-survivorship-a-portrait/

2. International Agency for Research on Cancer (IARC), GLOBOCAN 2012: Estimated Cancer Inci-dence, Mortality and Prevalence Worldwide in 2012. Available at: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx

3. C Allemani, H K Weir et al., “Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)”, The Lancet, Volume 385, No. 9972, pp.977–1010, March 14th 2015.

4. IARC, GLOBOCAN 2012.

5. Ibid.

6. M R Reich and K Shibuya, “The Future of Japan’s Health System—Sustaining Good Health with Equity at Low Cost”, New England Journal of Medicine, 2015; 373:1793-1797.

7. M Britnell, In Search of the Perfect Health System, Palgrave MacMillan, 2015.

8. Reich and Shibuya, “The Future of Japan’s Health System”, and Britnell, In Search of the Perfect Health System.

9. Ibid.

10. Reich and Shibuya, “The Future of Japan’s Health System”.

11. Britnell, In Search of the Perfect Health System.

12. Ibid.

13. Ibid.

14. Reich and Shibuya, “The Future of Japan’s Health System”.

15. Britnell, In Search of the Perfect Health System.

16. M Monden, “The basic plan to promote cancer control in Japan”, Gan To Kagaku Ryoho. 2013 May; 40(5):559-64.

17. M Takahashi, “Cancer survivorship: current status of research, care, and policy in Japan”, Japa-nese Journal of Clinical Oncology, 2016 Jul;46(7):599-604.

18. National Cancer Centre Japan, Annual Report 2014: Division of Cancer Survivorship Research. Available at: http://www.ncc.go.jp/en/publication/2014/ncccis/ncccis04.html

19. Takahashi, “Cancer survivorship: current status of research, care, and policy in Japan”.

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20. In this section, we highlight country-specific challenges that confront people who are living with or beyond cancer in Japan. Insights into more general challenges are discussed in The Economist Intelligence Unit, Providing integrated care for cancer survivors: The patients’ perspective, 2017. Available at: http://cancersurvivorship.eiu.com/providing-integrated-care-for-cancer-survivors-the-patients-perspective/

21. Takahashi, “Cancer survivorship: current status of research, care, and policy in Japan”.

22. National Cancer Centre Japan, Annual Report 2014: Division of Cancer Survivorship Research. Available at: http://www.ncc.go.jp/en/publication/2015/ncccis/ncccis04.html

23. H Yamani, “Cancer survivorship -current status in Japan”, Annals of Oncology, 2015; 26 (suppl_7): vii66.

24. Ibid.

25. National Cancer Centre Japan, Annual Report 2014.