Personalized cancer medicine: A reality across Japan

Abstract

The launch of personalized medicine based on human genome information has become widespread across Japan over the last few years. Against the expectation of patients, remarkable success occurs in less than 20% of patients in the most advanced hospitals in Japan [1,2], which is consistent with the rate in other countries. Nevertheless, the ability of cancer patients to access these state-of-the-art treatments is not equal, even in our government-supported universal health coverage system. Health professionals and clinicians in rural practice feel frustrated or incompetent for not being able to provide the best care based on the information they have learned. Most practicing doctors in the local community, like those in many other countries, have spent years sharpening their professional skills and continue to be very enthusiastic in following advances in medical science while they are involved with traditional daily patient care. This nature of the profession will be more prominent in the most diligent and sincere tier of medical professionals. In current medical education, the curriculum sometimes addresses “social justice rather than treating illness” [3]. The situation is not exactly the same in Japan, but still I share the same feeling during my 30 years of teaching in a medical school without a long history and tradition. It may be rarer in research universities, but almost every semester our curriculum committee has added a course on the social aspects of medical practice, ranging from appropriate bedside manner to holistic medicine in terminal patients. Teaching social justice alongside the medical curriculum are essential, although naïve students may not think of this as an “improvement“ as they prioritize keeping up with the cutting edge in medicine. The subsequent arguments that have arisen in the American literature are also instructive for us. The frequently debated issues differ from country to country and culture to culture; however, the competing priorities between patients’ merits, doctors’ enthusiasm for new therapies, and researchers’ curiosity are ubiquitous [4]. Correspondence between them is also available in the same journal [5]. No one would argue against that both biology and social justice are important. In the context of personalized medicine, we explored evaluating the delivery and availability of the latest genomic medicine and targeted therapy for germline diagnosis of familial cancer in Japan by inviting practitioners from local clinics, clinical oncologists from small local universities, and one of the national leaders of Japanese oncological medicine in performing systematic and basic cancer research. There may be a significant difference in the realization of genomic medicine between a central institute in Tokyo and other local and rural community hospitals. Again, both are important. We must realize and communicate with each other that differences exist everywhere. Practicing doctors in rural communities in Japan will argue they need more resources to launch their own “personalized medicine” system for all the cancer patients they take care of. The limited funding even in leading institutes in Japan forces locals to be patient until the “trickle down” effects reach peripheral institutes. In the internet era, an equality of access to information ironically irritates local doctors and some patients because their given therapy may not follow the rapid progress in genomebased therapy. On the other hand, rational people would probably ask whether “rapidly moving” means that the therapy is safe or effective. The answer is absolutely yes. Our expertise is poorly equipped with solving social prob-