Exploring the integration of psychological care in cancer treatment within Japan's unique cultural context
In Japan, a nation renowned for its longevity, cancer has been the leading cause of death for over four decades. With an aging population, more than a million people are diagnosed with cancer each year. While advancements in treatment have turned a cancer diagnosis from a death sentence into a potentially manageable condition, the journey remains profoundly challenging.
Beyond the physical toll, a hidden struggle often occurs—one involving fear, anxiety, and depression. This is the realm of psycho-oncology, a specialized field dedicated to addressing the psychological impact of cancer on patients and their families. In Japan, where unique cultural nuances shape communication and medical care, the development of this discipline has been both a revolutionary and essential endeavor, aiming to heal the mind while the body is treated 1 2 .
Psycho-oncology is a relatively new medical field, established in the 1970s in Western countries and introduced in Japan in the 1980s. It was born from a simple but powerful realization: a patient is more than just a collection of symptoms. This discipline scientifically investigates two core issues once neglected in traditional medicine 1 2 :
It focuses on the profound emotional effects a cancer diagnosis and its treatment have on patients, their families, and even healthcare providers.
It explores how behavioral and psychosocial factors, such as stress and social support, might influence cancer morbidity and mortality 3 .
In practice, psycho-oncology is an interdisciplinary endeavor. It bridges oncology, psychiatry, psychology, and nursing to provide comprehensive care that addresses not only the disease but the person behind it. Its ultimate goal is to safeguard and improve the quality of life, ensuring that a patient's mental wellbeing is given the same priority as their physical health.
The journey of psycho-oncology in Japan is deeply intertwined with shifting cultural norms. For much of the 20th century, the practice of "truth-telling"—informing a patient of a cancer diagnosis—was often avoided, with families and doctors sometimes colluding to shield the patient from the distressing truth. This began to change in the 1980s, as openness in medical communication gradually increased, creating a pressing need for psychological support 1 2 .
The field was formally born in 1986 with the establishment of the Japanese Society of Clinical Psycho-Oncology (now the Japan Psycho-Oncology Society), which held its first academic conference in 1987 1 2 . This provided a professional home for pioneers in the field. Major policy changes later catalyzed its growth. In 2002, palliative care services that included psychiatrists began to be covered by public health insurance. A pivotal moment came in 2007 with the National Cancer Control Act, which legally mandated that palliative care—including the management of psychosocial distress—should be available from the time of diagnosis, not just at the end of life 1 2 .
Japanese Society of Clinical Psycho-Oncology is established
Palliative care team services covered by national insurance
Increased integration of mental health specialists into cancer care 1 2 .
This legislative and professional backing has been crucial for making psycho-oncological care a standard, accessible part of cancer treatment in Japan.
Today, cancer remains a major public health concern in Japan. The psychological distress experienced by patients is significant and multifaceted. The most common psychiatric problems are adjustment disorders, major depression, and delirium 1 2 . The prevalence of major depression is estimated to be between 10% and 20%, similar to rates in other chronic illnesses, while up to 90% of advanced cancer patients receiving end-of-life care may experience delirium 1 2 .
Perhaps one of the most alarming statistics is the suicide risk. A Japanese study revealed that the suicide rate for people within the first year of a cancer diagnosis is more than 20 times higher than for the general population 1 2 . This risk is highest immediately after diagnosis, highlighting the critical need for early psychological intervention.
In response, Japan has built a structured care model. Leading institutions like the National Cancer Center have dedicated Departments of Psycho-Oncology 4 . These departments consist of teams of psycho-oncologists (psychiatrists or psychosomatic physicians), clinical psychologists, and nurses who provide both outpatient clinics and inpatient consultations. They work as integral members of palliative care teams, managing everything from medication for depression to non-pharmacological therapies for delirium and pain 4 .
To understand the innovative spirit of modern Japanese psycho-oncology, one can look to the SMILE AGAIN project, a fully decentralized clinical trial (DCT) that leverages smartphone technology 7 .
The fear of cancer recurrence is a very common and distressing symptom, particularly among young breast cancer survivors. Effective psychological treatments like cognitive behavioral therapy (CBT) exist, but there is a severe shortage of trained specialists. Furthermore, young survivors often have busy lives, juggling work and child-rearing, making it difficult to attend in-person therapy sessions 7 .
The SMILE project developed a novel solution: a smartphone-based intervention that allows patients to conduct CBT on their own time, without ever having to visit a hospital. The study was a randomized, controlled trial for women aged 20-49 who had undergone breast cancer surgery at least a year prior and were currently disease-free but feared recurrence 7 .
Participants were recruited nationwide through hospital posters with QR codes, newspaper ads, and social media, rather than through direct doctor referral.
Potential participants accessed a website with video explanations and animations. After verifying their identity, they provided consent electronically.
Participants used two specially designed smartphone apps for eight weeks: "Kaiketsu" (Problem-Solving) and "Genki" (Energy).
All data on outcomes like fear of recurrence were collected electronically through the ePRO system.
(Problem-Solving)
Taught structured problem-solving strategies to help patients manage challenges related to their condition.
(Energy)
Included behavioral activation and activity scheduling to help patients maintain energy and engagement.
The SMILE project successfully demonstrated that a fully remote, smartphone-based intervention could significantly reduce the fear of cancer recurrence in breast cancer survivors 7 . This was a landmark achievement, proving that effective psychological support could be delivered outside the traditional clinic. It greatly improved accessibility, allowing patients from all over Japan to participate in a clinical trial and receive support without the burden of travel. This pioneering approach to decentralized clinical trials has set a new standard for future psychosocial research and care delivery in Japan and beyond 7 .
The future of the field in Japan is being shaped by technology, precision, and a broadening scope of care.
Scientists are exploring biomarkers to predict which patients are most at risk for conditions like delirium or which might respond best to specific treatments 4 .
Furthermore, the focus is expanding beyond the patient to include families and specific populations. For instance, behavioral activation programs are now being adapted and tested for the bereaved families of cancer patients, who themselves are at high risk for depression 9 . There is also a growing emphasis on creating specialized support programs for adolescents and young adults (AYA) with cancer, whose needs differ from those of older adults or children 4 .
The story of psycho-oncology in Japan is one of remarkable transformation. From a time when a cancer diagnosis was hidden from patients to a present where psychological support is legally mandated, Japan has made significant strides in recognizing that curing a disease and healing a person are two sides of the same coin.
While challenges such as high suicide risk and the stigma surrounding mental distress persist, the field is responding with innovation, compassion, and scientific rigor. By continuing to integrate care for the mind with treatment for the body, Japan's psycho-oncologists are ensuring that the journey through cancer—however difficult—does not have to be walked alone.
The future of psycho-oncology in Japan lies in personalized, accessible, and comprehensive care that addresses the whole person, not just the disease.