Although there is treatment available to alleviate the pain of cancer patients, some excruciating misconceptions and the ignorance of medical workers are keeping it from widespread use here.
Fumikazu Takeda, the nation’s leading specialist in palliative cancer treatment, is trying to change that. He is the nation’s most outspoken advocate for the use of morphine for pain-killing.
“The medical climate surrounding cancer pain relief, which started at zero, has improved considerably in this country over the past decade,” said Takeda. “But our nation is still far behind other industrialized countries.”
A decade has passed since Takeda, president at the Saitama Cancer Center in Ina, Saitama Prefecture, published in July 1987 a Japanese translation of “Cancer Pain Relief” edited by the World Health Organization. It was the first of its kind in Japan, and since then Takeda has continued to write or edit other guidelines on how to alleviate pain in cancer patients.
More specifically, he has continued to lead the nation in promoting morphine for cancer treatment. “It is the best way to alleviate excruciating pain that mars the days of cancer patients,” said Takeda. “But still a large number of medical workers are not aware that they are responsible for saving patients from unnecessary, tormenting pain.”
According to Takeda, the amount of medically used morphine in each country can be correlated with the country’s advances in pain relief treatment. In 1994, Britain used 78.7 grams of morphine daily per 1 million people, compared with the 6.6 grams used in Japan, according to the Health and Welfare Ministry. In that same year, the corresponding figure in Canada was 71.5 grams, 71.3 in Australia, and 45.9 in the U.S., according to ministry statistics. “What is indispensable to improving the situation is raising awareness both among medical workers and the public that well-designed medication of morphine can effectively and safely control severe pain,” said Takeda.
Cancer has been the nation’s leading killer since 1981. In 1995, the latest year for which data is available, about 263,000 people died of cancer, or about 28.5 percent of all deaths that year. In those 12 months, about 910,000 cancer patients were treated at medical institutions, according to the health ministry.
“Pain causes additional fear and anxiety among patients, which often causes depression that tends to aggravate other symptoms of cancer,” Takeda said.
Reluctance to use morphine is still prevalent among doctors, some of whom believe that morphine can be addictive. “But appropriate use of morphine has nothing to do with addiction,” Takeda asserted.
But there are other roadblocks to morphine’s use here. Some patients are unwilling to receive morphine because of a misconception that it is only for terminally ill patients. “Every patient can benefit from morphine,” Takeda said. “Medically speaking, it is meaningless for cancer patients to endure pain and live in agony.”
A patient at the center, who underwent breast cancer surgery in April 1994 and now has a metastasis in the liver, said that she had at first wanted to avoid the use of morphine because she didn’t understand it. “But now I think that morphine has controlled the pain and I can sleep well,” she said. “I am very afraid of pain.”
Research conducted worldwide shows that pain is the most serious problem for about 70 percent of end-stage cancer patients, according to Takeda. However, research conducted at the Saitama Cancer Center showed that pain was totally removed with morphine treatment in 86 percent of patients, and nearly eradicated in another 11 percent of patients. Among the remaining 3 percent, pain was controlled to some extent, Takeda said.
However, Japanese doctors still commonly withhold the truth from patients when they are diagnosed with cancer, believing that telling the truth severely affects patients’ morale.
According to a national survey of 490 cancer center doctors conducted in 1993, only 24 percent said they always informed cancer patients of their condition. The survey, released in September 1994, was conducted by the National Cancer Center Hospital in Tokyo.
The figure represented an increase from the 10 percent reported in 1990. The same figure for doctors working at university hospitals was only 4 percent. “We have tried to understand the sufferings of patients in all sincerity, and the patients have appreciated our attitude,” Takeda said. “I believe that our experience has proved that telling cancer patients the truth is much better for them than continuing telling well-intentioned white lies.”