[Describing the Burdens on Patients and Healthcare Providers for Outpatient Chemotherapy-A Proceedings Paper].

Because the demand for outpatient chemotherapy has been increasing, the burdens on patients have recently become diversified, ranging from not only the physical burden due to hospital visits but also the psychological and financial burden due to the impact on employment. In addition, healthcare providers are currently facing a number of challenges in the management of outpatient chemotherapy, including labor shortages and equipment or system problems. On Tuesday, September 22,2020, an online meeting was held by the authors of this paper(moderator: Hiroko Bando)entitled" Describing the Burdens on Patients and Healthcare Providers for Outpatient Chemotherapy". This paper is the minutes of this conference and here we visualize the burdens on patients and healthcare providers and discuss the necessity of burden reduction or efficiency, measures to alleviate the burdens, and other topics.

Japanese Lung Cancer Society Guidelines for Stage IV NSCLC With EGFR Mutations.

Patients with NSCLC in East Asia, including Japan, frequently contain EGFR mutations. In 2018, we published the latest full clinical practice guidelines on the basis of those provided by the Japanese Lung Cancer Society Guidelines Committee. The purpose of this study was to update those recommendations, especially for the treatment of metastatic or recurrent EGFR-mutated NSCLC. We conducted a literature search of systematic reviews of randomized controlled and nonrandomized trials published between 2018 and 2019 that multiple physicians had reviewed independently. On the basis of those studies and the advice from the Japanese Society of Lung Cancer Expert Panel, we developed updated guidelines according to the Grading of Recommendations, Assessment, Development, and Evaluation system. We also evaluated the benefits of overall and progression-free survival, end points, toxicities, and patients' reported outcomes. For patients with NSCLC harboring EGFR-activating mutations, the use of EGFR tyrosine kinase inhibitors (EGFR TKIs), especially osimertinib, had the best recommendation as to first-line treatment. We also recommended the combination of EGFR TKI with other agents (platinum-based chemotherapy or antiangiogenic agents); however, it can lead to toxicity. In the presence of EGFR uncommon mutations, except for an exon 20 insertion, we also recommended the EGFR TKI treatment. However, we could not provide recommendations for the treatment of EGFR mutations with immune checkpoint inhibitors, including monotherapy, and its combination with cytotoxic chemotherapy, because of the limited evidence present in the literature. The 2020 Japanese Lung Cancer Society Guidelines can help community-based physicians to determine the most appropriate treatments and adequately provide medical care to their patients.

Differences in cancer patients' work-cessation risk, based on gender and type of job: Examination of middle-aged and older adults in super-aged Japan.

OBJECTIVES: In this paper, we aim to estimate the effect cancer diagnosis has on labour-force participation among middle-aged and older populations in Japan. We investigate the impact of cancer diagnosis on job cessation and the gap between gender or job types. METHODS: We sourced data from a nationwide, annual survey targeted population aged 51-70 featuring the same cohort throughout, and examined respondents' cancer diagnoses and whether they continued to work, while also considering differences between gender (observations: 53 373 for men and 44 027 for women) and occupation type (observations: 64 501 for cognitive worker and 20 921 for manual worker) in this regard. We also examined one-year lag effects, using propensity score matching to control for confounding characteristics. We also implement Logistic regression and derive the odds ratio to evaluate the relative risk of cancer diagnosis, which supplements the main result by propensity score matching. RESULTS: Overall, the diagnosis of cancer has a huge effect on labour-force participation among the population, but this effect varies across subpopulations. Male workers are more likely to quit their job in the year they are diagnosed with cancer (10.1 percentage points), and also in the following year (5.0 percentage points). Contrastingly, female workers are more likely to quit their job immediately after being diagnosed with cancer (18.6 percentage points); however, this effect totally disappears when considering likelihoods for the following year. Cognitive workers are more prone to quit their job in the year of diagnosis by 11.6 percentage points, and this effect remains significant, 3.8 percentage points, in the following year. On the other hand, for manual workers the effect during the year of diagnosis is huge. It amounts to 18.7 percentage points; however, the effect almost disappears in the following year. CONCLUSION: Our results indicate the huge effect of cancer on job cessation, and that there might be a degree of discrimination in workplaces between gender and job types.

[From the Viewpoint of Cancer Patient].

Under the Cancer Control Act, the patient involvement in cancer policies has been legislated, and the voices of cancer patients have been reflected in the equalization of cancer medical care and the solution of medical drug lag. Decision support for treatment of cancer patients is being provided, including advanced care planning. On the other hand, the Cancer Societies in Japan has established a patient participation program, and the system will be established in which patients can participate in study design and evaluation in the national cancer control basic plan. Efforts to the patient and public involvement are beginning to take place at Japan Agency for Medical Research and Development(AMED)and clinical research groups.

The Japanese Lung Cancer Society Guideline for non-small cell lung cancer, stage IV.

According to rapid development of chemotherapy in advanced non-small cell lung cancer (NSCLC), the Japan Lung Cancer Society has been updated its own guideline annually since 2010. In this latest version, all of the procedure was carried out in accordance with grading of recommendations assessment, development and evaluation (GRADE) system. It includes comprehensive literature search, systematic review, and determination of the recommendation by multidisciplinary expert panel which consisted of medical doctors, pharmacists, nurses, statisticians, and patients from patient advocacy group. Recently, we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors. Thus, the guideline proposes to categorize patients into three entities: (1) driver oncogene-positive, (2) PD-L1 ≥ 50%, and (3) others. Based on this subgroup, 31 clinical questions were described. We believe that this attempt enables clinicians to choose appropriate treatment easier. Here, we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC, stages IV.

[The Framework of the Amended Cancer Control Act].

The Cancer Control Act approved in 2006 was amended in December 2016 by the nonpartisan federation of the National Assembly, while meeting the requests from cancer patient groups. In the chapter on the basic ideas, it is said that cancer control needs to advance the development ofthe social environment that enables cancer patients to run a smooth social life and employment support for cancer patients and promotion of cancer education are newly stated. In the chapter on the basic measures, palliative care, rehabilitation, the research on rare cancer and intractable cancer, the treatment ofchildhood cancer patients and the improvement of educational environment for those patients, and the support for private organizations and cancer patient groups are newly stated. Regarding cancer genome medical care, new legislation is expected.

[Now and the Future of Survivorship Support of Cancer Control in Japan].

Based on the Cancer Control Act approved in June 2006 and the National Cancer Control Plan, cancer control promotion council including cancer patients in Ministry of Health, Labor and Welfare(MHLW)has discussed about cancer survivorship from the viewpoint of the reduction of economic burden on cancer patients and supporting cancer patients to be independent and MHLW has taken measures especially in the employment support for cancer patients. On the other hand, cancer survivorship is a theme related to general living of cancer patients after cancer diagnosis. In order to promote measures on cancer survivorship in Japan, not only the employment support for cancer patients but also the research and support for multifaceted areas are needed.