Tomone Watanabe

Introduction Anticancer therapy for non-small cell lung cancer in patients ≥ 75 years has evolved with accumulating evidence. Recent guidelines recommend that treatment decisions be based on functional status rather than age alone. However, disparities in treatment rates persist between those above and below 75 years. This study examined whether evidence supporting treatment in older patients influences implementation, comparing trends over time by age groups. Methods A hospital-based cancer registry covering designated cancer centers was linked with a Diagnosis Procedure Combination database, which records all medical interventions at each facility, capturing approximately 50% of lung cancer cases in Japan. For patients ≥ 75 years with good performance status, the implementation rates of standard anticancer therapy were analyzed by disease stage in 2021 and trends from 2016 to 2021. Results In 2021, all standard treatments, except oral molecular-targeted therapies for patients with unresectable cancer, were administered less frequently to those ≥ 75 years. Treatments with evidence established before 2016 were stable throughout the study period. Oral molecular-targeted therapies demonstrated no age-related differences, and adjuvant cytotoxic chemotherapy was less frequently administered to patients ≥ 75 years. In contrast, treatments validated in patients ≥ 75 years after 2016 demonstrated a significant trend towards higher implementation, approaching that in younger patients. Immune checkpoint inhibitors, for which safety and efficacy in older patients remain uncertain, exhibited increasing divergence in implementation rates between age groups over time. Conclusion Evidence supporting the efficacy and safety of therapies in individuals ≥ 75 years may influence treatment selection over time.

Background: The accuracy of patient-reported clinical information, including cancer stage, is not well understood. This study aims to evaluate the agreement between patient-reported survey data and clinical information recorded in hospital-based cancer registries (HBCR). Methods: A total of 730 patients from 166 hospitals in Japan were randomly selected and informed that their survey responses would be validated against HBCR data. Demographic details, including age, sex, cancer stage, and cancer site, were recorded and compared with clinical data from the HBCR. Agreement rates between patients’ self-reported demographic and clinical data and the corresponding HBCR records were analyzed. Logistic regression analysis was conducted to identify factors associated with accurate reporting of cancer stage information. Results: Agreement rates for age, sex, and cancer site were 99.4%, 99.8%, and over 90% across all cancer sites, respectively. The agreement rate for cancer stage reporting was 49.9%. Patients with stage IV cancer had the highest agreement rate at 68.4%. Patients under 75 years of age and those with specific cancer types demonstrated higher odds of reporting data consistent with HBCR records. Conclusions: For cancer stage data, relying on more credible sources, such as cancer registries, is recommended over patient-reported information to ensure accuracy.

Objective: The hospital-based cancer registry is used extensively for research to support cancer control activities by providing an overview of how cancer treatments are provided nationwide. This study aimed to shed light on the quality and characteristics of treatment data in the hospital-based cancer registry using the linked dataset on gastric cancer. Methods: Using the nationally linked data of the hospital-based cancer registry and the health services utilization data, the treatment data in the hospital-based cancer registry for patients who were newly diagnosed with gastric cancer in 2016 and 2017 and received the first course of treatment at their own institutions were examined. The agreement rates between registry data and utilization data were analyzed by stage, treatment, age, period from the date of diagnosis to the date of treatment and hospital type. Results: The sensitivity of open surgery, laparoscopic surgery and endoscopic treatment tended to decrease in advanced stages, whereas the sensitivity of chemotherapy and radiation therapy increased. Specificity was high for all treatments and stages, at ˃90%. Sensitivity by age was slightly different for chemotherapy and radiation therapy, but specificities did not differ. For all treatments, the longer the time from diagnosis to treatment implementation, the higher the coverage rate. Conclusions: The hospital-based cancer registry recorded the treatment performed appropriately. It is necessary to interpret the data from the hospital-based cancer registry whilst keeping in mind that, chemotherapy and radiation therapy are registered less frequently than surgical treatments administered.

Background The accuracy of the patient-reported clinical data remains largely unknown. This study aims to assess the level of agreement between the responses of patients in surveys and actual information obtained from hospital-based cancer registries (HBCR). Methods A total of 1,671 patients from 166 hospitals across Japan were randomly selected and invited to participate in the survey, and primary data of a nationwide survey was analyzed, which was collected from January 2019 to July 2019. A group of patients were informed prior to the survey conduction that the validity of their responses would be assessed in correlation with the HBCR. Patient demographics such as age, sex, cancer stage, and cancer sites were noted, and survey responses were compared with the clinical information extracted from hospital-based cancer registries. The agreement rates between the patients’ self-reported demographic information and the information from the registry was compared. Further, logistic regression was used to identify the factors contributing to the accurate reporting of cancer stage information. Results It was noted that although patients’ responses regarding age, sex, and cancer site were quite accurate, the agreement rate between patients’ responses and cancer stages mentioned in hospital-based cancer registries was approximately 48.1%. The stage-stratified agreement rate was the highest (67.7%) for stage IV cancers. Younger and female patients were found to have more accurate information than older and male patients. Conclusions Although utilizing patient-driven information in the policy-making process is helpful, researchers and policy makers must verify the accuracy of this information.

Drug lag refers to the difference in the time of a new drug's approval in different countries; the dissemination of the new drug after approval within the countries is another problem. We examined the nationwide dissemination of 11 cancer drugs approved in Japan between 2011 and 2015 using the National Database of Health Insurance Claims data. We extracted data on the number of cancer drug prescriptions from 47 prefectures and associated demographic information, such as age and sex. Eight diabetes drugs were also examined for comparison. We observed a lag between the marketing approval date of the drugs and their first use. To further explore the rise and pattern of each drug’s dissemination, we analyzed the trend of the cumulative number and total of new prescriptions for each prefecture. The results showed that the first month of new cancer drug prescriptions varied across prefectures. On average, they lagged by up to 2 months in the slowest prefectures, whereas the variation was almost nonexistent for diabetes drugs. The patterns of dissemination varied more among cancer drugs across the seven Japanese geographical regions. After the initial prescription, the number of prescriptions showed a steep rise for most cancer drugs, whereas the increase was gradual for diabetes drugs. In conclusion, the dissemination of cancer drugs had a greater lag time than that of diabetes drugs. Further research is needed to explore the causative factors to ensure that all effective drugs are equally accessible for those who need them.

Background: To elucidate the experience of patients with cancer from diagnosis to early survivorship in Japan using a nationwide questionnaire survey, and to inform the current progress of the cancer control programs. Methods: The survey was sent to a representative sample of adult patients with cancer identified from the national database of hospital-based cancer registries. The patients’ responses were compared across three groups: patients with rare cancers, patients aged < 40 years, and patients with non-rare cancers aged ≥40 years. Results: Of 20,488 patients invited to participate in the survey, 8935 (43.6%) responded. Respondents reported an average score of 7.9 out of 10 on global ratings of care. Patients with rare cancers experienced a longer time to diagnosis but the shortest time from diagnosis to first treatment (p < 0.05). Patients aged < 40 years rated worse for the majority of the survey items, especially on items that related to communication with medical staff and items referring to early survivorship. Conclusion: The care experienced by patients with cancer in Japan varies on the basis of age group and cancer type. Efforts should be directed to ensuring prompt access to diagnostic facilities for patients with rare cancers and providing sufficient support to younger patients.

Reports on the expenditure of cancer treatments per patient using comprehensive data remain unavailable in Japan. This study aimed to use Japan’s cancer registry data and health service utilization data for evaluating the disease-specific, per-patient costs of five major cancers—stomach, lung, colorectal, liver, and breast cancers. We used a database linking the 2017 data from a hospital-based cancer registry and the health service utilization data from the Diagnosis Procedure Combination survey. All patients who started their first treatment course at each hospital were included. The costs were calculated using the total volume of the health services provided and the unit fee information included in the data. We analyzed 304,698 patients. Lung cancer had the highest healthcare cost per-patient for the first year of diagnosis and the longest median hospitalization duration. Conversely, breast cancer showed the lowest cost and the shortest median hospitalization duration. However, in the first month after diagnosis, colorectal cancer showed the highest cost. Subsequently, the gaps between the costs of the five common cancers drastically diminished. The cancer type having the longest hospitalization duration had the highest overall healthcare resource utilization costs. This information is essential for care planning and research studies.

The International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer did not take into account any of the findings determined by imaging modalities as part of the staging work-up. However, in the Japanese clinical settings, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used. In this study, we aimed to describe the pretreatment use of sensitive imaging modalities in Japan in order to assess the future adaptability of the FIGO staging system.Data from September 2012 to December 2014 were collected from the National Database of the Hospital-Based Cancer Registry and health insurance claims data. A total of 280 hospitals participated. From the database, all patients with cervical cancer who received first-line therapy at the participating hospitals were analyzed. The proportions of patients who had CT, MRI, and positron emission tomography-CT (PET-CT) before receiving the first-line therapy were calculated. For comparison, the proportions of patients who had undergone cystoscopy and/or proctoscopy -- examinations that are incorporated into the FIGO system -- were also calculated. A total of 13 668 patients were included; 77.3% of patients had early stage (stage 0 or I) disease. Among all patients, 88.5% had undergone CT, MRI, or PET-CT before receiving the first-line therapy. Additionally, over 90% of patients with advanced-stage (stage II–IV) disease had undergone CT. Conversely, only 21.0% of patients with stage II–IV disease were reported to have undergone cystoscopy and/or proctoscopy. Promoting a resource-stratified approach in the cervical cancer staging is warranted.

Watanabe T, et al. J Gynecol Oncol. 2017 Dec;29:e83. https://doi.org/10.3802/jgo.2018.29.e83