The development of cancer pain management and palliative care over the last 5 years in Japan

After the release of the World Health Organization guidelines in 1986, palliative care units (PCUs) were authorized to offer effective cancer pain management under the Japanese National Health Insurance in 1990. Although the number of PCUs increased to more than 100 during this decade, they could only cover 5% of all terminal-stage cancer patients in Japan. Due to the resistance to opioids together with the delay in establishing oncology practice, palliative care including cancer pain management was offered only to terminal cancer patients in PCUs, and cancer pain management did not improve sufficiently in general practice during the 1990s. To change the situation, the concept of hospital-based palliative care teams (HPCTs) were introduced into general hospitals and covered by the National Health Insurance in 2002. The HPCT mainly acts as a consultation team to help primary physicians or nurses who care for cancer patients in a general hospital. After the initiation of HPCTs, the role of palliative care in Japan is gradually changing because the HPCTs have been required to cover not only the terminal phase, but also overall cancer care. In addition to the spread of HPCTs, the types and formulations of opioids available and education on cancer pain management has also improved during the last 5 years. To further improve cancer pain management and palliative care in Japan, a triangle system should be established to offer seamless care in all healthcare settings based on the coordination among PCUs, general hospitals with HPCTs, and home-based care. This is referred to as a “palliative care program”.