MD Anderson takes its 'normal' to Japan
By Sandi Stromberg
In 2000, Naoto Ueno, M.D., Ph.D., traveled to Japan to talk about Herceptin for breast cancer patients. But he also listened. To patients, investigators, scientists, surgeons.
What struck him repeatedly was the Japanese approach to cancer drug development, treatment and patient care. While he had received his medical degree in Japan, he’d never practiced medicine there, never experienced its hierarchical nature or its traditions. Though he had a deep respect for them, he also knew how beneficial
MD Anderson’s multidisciplinary care was for patients and health care professionals.
“Could Japan benefit from this approach?” he asked himself. “Would it translate into another culture?”
“I didn’t know how we could teach it,” says Ueno, professor in MD Anderson’s departments of Breast Medical Oncology and Stem Cell Transplantation and Cellular Therapy. “I just knew that MD Anderson faculty did a good job of it. For us, it’s normal. I wasn’t even sure how to define it.”
But he decided to try.
A 10-year evolution
The biggest challenge was to be culturally sensitive, honoring Japanese pride in their more paternalistic style of leadership while introducing a different way of thinking.
The other challenge was defining “multidisciplinary” and how to translate it. “Multidisciplinary is hard to pronounce in Japanese,” Ueno says. “But the word ‘team’ is easy, and ‘oncology’ has become a rather well-known term. Team Oncology sounded good in Japanese so we decided to call this the Japan Team Oncology Program, or JTOP.”
And that helped with the definition that began to take shape: cancer care delivered by representatives of a variety of health care professions and functions working in concert. At MD Anderson, not only do surgical, radiation and medical oncologists work together to provide patient care, but also mid-level providers like advanced practice nurses, pharmacists and others are encouraged to expand their roles and take part in decision-making processes.
Over the last 10 years Ueno’s efforts, and those of the team he inspires, have evolved from a virtual presentation to 1,000 members of the Japanese Society of Clinical Oncology in 2001, into three-day educational workshops each autumn since 2002, as well as training programs at MD Anderson each spring since 2003. More recently, a website — explaining the institution’s multidisciplinary concept in Japanese — receives 70,000 hits a month.
To date, JTOP has trained more than 420 Japanese health care professionals, many of whom are in leadership positions promoting multidisciplinary care in different oncology centers in Japan. And 49 of those trained at MD Anderson provide similar workshops in their medical communities.
“Our greatest, collective accomplishment, however,” Ueno says with great pride, “was our influence on the Japanese Diet’s passage of the Cancer Act, similar to the one President Nixon signed in 1971. Initiated in spring 2007, it includes professional funding for promoting multidisciplinary cancer care in Japan and for oncology professional development in 18 regional areas of the country.”
A cohesive team of experts
Intent on ensuring the program is stable and ongoing, Ueno has masterfully galvanized a team of experts to help it grow. The dedicated MD Anderson team comprises surgical, radiation and medical oncologists, clinical statisticians, nurses and pharmacists.
In 2002, he recruited, among others, Richard Theriault, D.O., professor in the Department of Breast Medical Oncology, who is a member of JTOP’s newly established Management Executive Committee.
“I went for the first workshop, and it was a phenomenal event,” Theriault says. “Although it was no surprise, we were quick to see that in Japan the system is dramatically different. Multidisciplinary care, as we understand it, is a team of health care professionals working together for the common good of the patient. Things aren’t quite that open in Japan.
“But these workshops set out to explain what multidisciplinary care is, how it’s practiced at MD Anderson, what training nurses and pharmacists receive and how they do their jobs.”
"The majority of cancer patients in Japan are not seen by oncologists, but rather by surgeons specialized in a certain type of surgery, be it breast, thoracic, gastrointestinal. It's the surgeon who takes care of the patient through chemotherapy, radiation and any other type of therapy. Only recently are there two programs that offer oncology training and certification."
— Richard Theriault, D.O., professor,
Department of Breast Medical Oncology
Each year, after general presentations, the 60 participants split into groups of 15 with five surgeons, five nurses and five pharmacists in each. Then, they are given the task of developing a clinical trial.
“It’s very intense,” Theriault says. “A physician helps lead each team while a biostatistician roams from group to group, and the three professions work together to design a clinical trial and prepare to present it to the other participants the next morning.”
Directly after those presentations, Ueno, Theriault and the other MD Anderson experts discuss each attendee as they choose six people — two physicians, two nurses, two pharmacists — who will travel to MD Anderson for a five-week training course the following spring. They weigh criteria such as the person’s resume, participation in the presentation and level of English.