[Special Feature: Cancer and Society] Kaori Yagasaki: Supporting the Lives of Patients Living with Cancer—From a Cancer Nursing Perspective

Cancer has been the leading cause of death in Japan since 1981. In recent years, cancer incidence rates have risen, and it is estimated that approximately one in two people will develop cancer in their lifetime. Although various cancer control measures are being promoted, cancer remains a serious issue for people's lives and health. In this article, I would like to discuss cancer control measures, as well as nursing and team medicine that support patients and families living with cancer in society.

A major turning point in Japan's cancer control was the enactment of the Cancer Control Act on June 23, 2006 (Act No. 98). A key challenge identified was ensuring that cancer patients (including cancer survivors) can receive necessary support comprehensively according to their situation. To further enhance cancer control, the act established basic principles, clarified the responsibilities of the national government, local governments, medical insurers, citizens, physicians, and employers, and set forth matters regarding the formulation of plans for promoting cancer control and the fundamentals of cancer control measures.

With the goal of achieving the equalization of cancer medical care—ensuring that cancer prevention, early detection, and cancer medical care are available to everyone, everywhere, without regional disparities—various cancer control plans have been formulated. Consequently, cancer-related research, education, and practice have undergone accelerated changes. At the same time, the rapid development of drug discovery and medical care related to cancer has expanded the possibilities for cancer patients to lead social lives while receiving treatment. Supporting the social lives of patients living with cancer is a critical issue.

As part of the infrastructure development for the Basic Plan to Promote Cancer Control, the promotion of "strengthening human resource development" was advocated, and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) subsidized project, the Cancer Professional Training Plan, started in 2007. This project aims to train medical professionals capable of handling the future sophistication of cancer medical care. It involves 76 national, public, and private universities nationwide that have established graduate schools of medical sciences, along with related medical institutions, developing and implementing excellent educational programs and collaborating to provide them across universities. To date, the first through third phases of the project have been promoted every five years. Currently, the fourth phase (starting from fiscal year 2023), the Next-Generation Cancer Professional Training Plan, is training human resources to address issues becoming apparent in the field of cancer medical care. Furthermore, initiatives have expanded beyond graduate education to train a wide range of personnel involved in researcher development and regional cooperation. At the same time, this is not a provider-centered project; it emphasizes the development of patient- and citizen-participatory cancer medical care.

Our university's graduate school involves the collaboration of three graduate schools (Medicine, Nursing, and Pharmacy): the Graduate School of Medicine, the Graduate School of Health Management (Nursing Major), and the Graduate School of Pharmaceutical Sciences. We have been selected for the "Cancer Pro Project" from the first through the fourth phases, offering and promoting various courses to train specialists who lead advanced cancer medical care. The ability to promote highly specialized practice, education, and research, as well as collaboration and cooperation across each graduate school, is a strength of our university.

The Nursing Major at the Graduate School of Health Management trains nursing practitioners, educators, and researchers who lead advanced cancer medical care through master's and Ph.D. programs. The master's program includes a Certified Nurse Specialist (CNS) educational curriculum, training CNSs in various fields such as psychiatric nursing, genetic nursing, and gerontological nursing, in addition to cancer nursing.

A Certified Nurse Specialist is an individual who has acquired advanced knowledge and skills in a specific specialized nursing field through a master's program, passed the CNS certification examination after graduation, and is recognized as having outstanding nursing practice abilities. They are expected to efficiently provide high-level nursing care to individuals, families, and groups with complex and difficult-to-solve nursing problems. Among them, Cancer Certified Nurse Specialists have the role of understanding the holistic suffering of cancer patients and providing high-level nursing from the perspective of QOL (Quality of Life) for patients and their families. However, the number of nurses holding the Cancer CNS certification in Japan is 1,133 (as of December 2024), which still cannot be considered many. From the perspective of equalizing cancer medical care, we aim to further strengthen the training of CNS personnel.

Although cancer control measures have been strengthened, from the perspective of cancer patients, aren't there still many diverse issues piled up? Are the needs of individual patients and families being met? Are they convinced by, reassured by, and satisfied with their own treatment and care?

In recent years, cancer medical care and drug discovery have advanced, and methods to alleviate side effect symptoms have also been developed, making it possible for patients to live in society with cancer while receiving treatment. However, by applying new therapeutic drugs and methods, patients gain therapeutic effects while also experiencing new side effects and sequelae, which can become factors that hinder daily life or lower QOL. Derived from these diverse physical symptoms, issues such as work and family problems, economic issues, and interpersonal relationships also affect one's way of life and life itself. For example, we hear of patients facing social challenges such as, "Since receiving cancer drug therapy, numbness remains in my hands and feet, I can't put strength into them, and I'm unsure when to return to work," or "I don't know when my condition might worsen, so responsible work is difficult." There are also cases where skin disorders caused by side effects of cancer drugs (pigmentation, acne-like rashes, hand-foot syndrome, etc.) are perceived as "skin diseases" by those around them, leading to prejudice and misunderstanding. The accumulation of such experiences can shake one's self-esteem.

Furthermore, patients may live with functional changes, losses, and sequelae, such as the creation of an artificial anus for the treatment of colorectal cancer, or loss of voice due to the resection of the area around the vocal cords for laryngeal or pharyngeal cancer. In other words, the end of cancer treatment does not mean that pain and burdens are resolved; we must understand that people who have experienced cancer face and cope with diverse challenges in society.

Support to alleviate this multifaceted, holistic suffering is an important role of nurses. Nurses provide individualized care to comprehensively capture the lives and experiences of cancer patients and to improve their QOL while living with cancer. Among these, in situations involving complex and difficult problems, Cancer Certified Nurse Specialists are expected to deploy more advanced practices, find clues to solutions, and lead to improvements.

In addition, there are limits to solving the diverse suffering of cancer patients through a single profession, such as only doctors or only nurses. It is beneficial to function as a team to solve complex issues by utilizing the expertise of each specialist through collaboration and cooperation with multiple professions (nurses, doctors, pharmacists, dietitians, physical therapists, social workers, etc.). In recent years, the term "team medicine" has become widespread, and the placement of designated specialized personnel is even a condition for additional medical fee reimbursements in some cases. In cancer care, various teams composed of multiple professions—such as palliative care teams, pain relief teams, nutrition support teams, and regional cooperation/discharge support teams—operate across departments within facilities, though names vary by institution. In these teams, Cancer Certified Nurse Specialists contribute to the smooth provision of multidisciplinary care by taking a neutral stance, considering the patient's intentions and values, and acting as coordinators or sometimes leaders between the patient and the multidisciplinary team, or among the various professionals themselves.

When active treatment ends and the follow-up period begins, the frequency of outpatient visits decreases, and patients have fewer points of contact with medical professionals. To ensure that patients and families do not feel lost or isolated regarding who to consult about cancer anxiety, medical care, work, school, or daily life difficulties, Cancer Counseling and Support Centers have been established in recent years at "Designated Cancer Hospitals," "Pediatric Cancer Hub Hospitals," and "Regional Cancer Hospitals" nationwide. Although the names vary by facility, anyone can consult about various cancer-related matters at any time, regardless of their diagnosis or treatment status. Places and opportunities for continuous support are provided where patients can consult about doubts and anxieties regarding all aspects of life, including recuperation and returning to society. Furthermore, an increasing number of facilities are establishing specialized nursing outpatient clinics for stoma care or cancer pain care, and conducting nursing consultations for visiting patients. Additionally, cancer specialty hospitals have established telephone consultation desks so that anyone can seek advice.

The challenges faced by people living with cancer differ for each individual. Nurses stand from the patient's perspective and strive to provide support that brings them even one step closer to a solution. We must continue to strive for maintenance and improvement so that people living their social lives with cancer do not become isolated, can fully utilize social support systems, and can easily access appropriate information.

In addition, to ensure that cancer patients can lead their social lives with peace of mind, educating and raising awareness about basic knowledge of cancer, treatment, and side effects among all ages—from children to the elderly, regardless of whether they have cancer—will make it easier for cancer patients to gain understanding and support from those around them and society. Furthermore, even if one develops cancer themselves, having a certain level of knowledge may increase their repertoire of coping behaviors.

Cancer is not just an individual problem; it can be called a challenge for society as a whole. To improve the quality of cancer medical care, the training of medical professionals as mentioned above is indispensable. By having multiple professions acquire specialized knowledge and skills, continuing self-improvement, and providing high-quality medical care, it will be possible to expand the possibilities of cancer patients' lives and make them richer. We aim for the development of a society where patients and their families can live with peace of mind.