2023 Fiscal Year Final Research Report

An Empirical Study to Evaluate the Impact of the Designated Cancer Care Hospital System on the Equalization of Cancer Care

Research Project

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Project/Area Number	19K19452
Research Category	Grant-in-Aid for Early-Career Scientists
Allocation Type	Multi-year Fund
Review Section	Basic Section 58030:Hygiene and public health-related: excluding laboratory approach
Research Institution	National Center for Global Health and Medicine (2021-2023) Osaka International Cancer Institute (2019-2020)
Principal Investigator	Okawa Sumiyo 国立研究開発法人国立国際医療研究センター, 国際医療協力局, 上級研究員 (50747673)
Project Period (FY)	2019-04-01 – 2024-03-31
Keywords	がん登録 / がん診療連携拠点病院 / 診療実績 / 手術 / ホスピタルボリューム / 生存率 / 医療の均てん化 / 医療の集約化
Outline of Final Research Achievements	This study revealed that the designated cancer care hospital (DCCH) system has contributed to the equalization of medical care in Japan. The 3-year survival probability of cancer patients who underwent surgery at the national and Osaka prefecture DCCHs were 7.8% and 5.4% higher, respectively, than those at non-DCCHs. The disparity in the 3-year survival probability of surgically-treated patients among national and prefectural DCCHs decreased after the introduction of the DCCH system (2007-2009, 2010-2012) compared to before the introduction of the system (2004-2006). The DCCH system sets an annual surgical volume requirement, and our analysis of the association between the annual surgical volume and the 3-year survival probability of patients at the DCCHs showed the join point at 200-249 surgeries per year, based on which we considered this requirement appropriate.
Free Research Field	公衆衛生・疫学
Academic Significance and Societal Importance of the Research Achievements	がん診療連携拠点病院制度は、がん医療均てん化の推進を目指す政策として導入された。本研究は、大規模で精度の高い大阪府がん登録のデータを用いて分析し、拠点病院で手術を受けた患者の生存率が高いことや、拠点病院間での生存率の格差が縮小傾向にあることを明らかにし、この制度が医療の均てん化に貢献してきたことを示唆した。また、拠点病院の指定要件をエビデンスに基づいて設定することの重要性も示した。全国がん登録のデータを用いれば、全国や他の都道府県を対象とした同様の分析が可能である。本研究はがん診療連携拠点病院制度の今後の在り方の検討に資するエビデンスを創出することができた。