Epithesis — offering appearance care to cancer patients

A major concern accompanying cancer treatment is the change to a person's appearance.

As more focus is placed on providing cancer patients with appearance care to mitigate their psychological burden, epithesis — an artificial reconstruction of a body part — is also attracting attention.

Patient-specific epitheses that recreate each individual’s features including shape, skin color and wrinkles help them regain confidence in their day-to-day lives.

However, there are issues such as the shortage of epithesists with a high level of skill.

Reducing the burden

At Ikeyama Medical Japan’s factory in Nagoya, 36-year-old epithesist Midori Kaoka was holding an ear-shaped epithesis in her hand that had been sent back to her for maintenance.

“I’m sure this has always been used with great care,” she said.

Kaoka created the epithesis roughly five years ago at the request of a young woman who had her ear removed in surgery to treat skin cancer.

She had met the woman many times to go through the processes of making a cast to adjusting the color. She also pierced the earlobe of the epithesis so the customer could wear earrings.

Epitheses are detachable artificial devices that are used as a replacement for body parts lost due to accidents or surgery. They are made of soft, colored silicone.

Ikeyama Medical Japan is an established firm that has been in the business since the 1980s. Six epithesists work at the firm to create customized epitheses.

Unlike prosthetic hands or legs that assist amputees in retrieving the shapes and functions of their body parts, epitheses are intended to improve aesthetic appearance.

Epithesists aim to make the products look as natural as possible, including through wrinkles, fingerprint patterns, veins and texture.

The products are not covered by insurance in principle, and are priced at hundreds of thousands of yen.

While it takes months to complete them, orders keep coming, including from overseas.

“I always feel nervous when I show the finished product, but I feel happy the moment I see a customer’s face brighten up,” Kaoka said.

Nurturing epithesists a challenge

Half of the firm's orders come from people who have had a breast removed due to breast cancer.

A 65-year-old woman from Aichi Prefecture who made an order more than a decade after she underwent surgery said, “Before I had it made, I used a private bath when I went on a trip because I was worried about how others saw me, but now I can enjoy going to large baths.”

There are also many customers who have lost a part of their face.

A 62-year-old man from Nagoya always wears a nose-shaped epithesis made by the firm except when he goes to bed.

Paranasal sinus cancer surgery conducted six years ago has left him with a nasal deformity.

“My work involves meeting many people, so (an epithesis) is a daily necessity,” he said.

The need for epitheses is expected to increase as more cancer patients return to participating in social activities, but the firm says increasing production is difficult as it requires closely communicating with the customer.

“Annual production of 300 is the maximum we can handle,” says Noriyuki Ikeyama, 65, the firm’s president. “Nurturing people who can engage in the work is urgently needed."

Unlike prosthesists and orthotists who require national qualifications, there are no such qualifications or standards needed to become an epithesist.

The firm offers training sessions to foster future epithesists, but guaranteeing quality has been a challenge.

“We want to somehow spread epithesis so that people worried (about their appearance) can have options,” Ikeyama said.

Appearance care

The government’s fourth basic plan to promote cancer control programs, which covers a period of six years from the current fiscal year, attaches more importance to appearance care.

More municipalities are offering subsidies for cancer patients buying wigs after losing hair due to chemotherapy.

According to Keisuke Takanari, 45, head of Aichi Cancer Center’s Department of Plastic and Reconstructive Surgery, awareness of appearance care has increased in the past decade.

The main reason is because cancer patients are experiencing less physical pain than before thanks to the advance of antiemetics — drugs to stop vomiting and nausea — and it has become easier for them to lead a social life with the increase of outpatient treatments.

There are various appearance care options including epithesis, makeup, wigs and reconstructive surgery, but it is up to patients themselves to decide what kind of care they want to receive at which stage.

Experts recommend patients to prepare early for expected hair loss, but depending on the state of illness, making early preparations for appearance care could make some patients reluctant to undergo treatment.

It is important for the patients to discuss closely with medical professionals and think of how to balance treatment with expectations.

The center plans to boost support for patients by setting up a team of medical staff dedicated to appearance care.

Patients can also seek advice at cancer consultation and support centers in designated cancer hospitals nationwide.

“Appearance care is part of cancer treatment,” Takanari said. “Patients can consult medical workers any time, before or after treatment, if they have worries.”