Analysis of the Standardization and Centralization for CancerTreatment in Nagasaki Prefecture

In medical care systems for cancer, it is important to consider the issues of standardization and centralization.In this study, we employed the Nagasaki Cancer Registry, which has a high registry rate, to investigatestandardization and centralization for five major cancers, in addition to childhood malignancies (which areoften rare types). Subjects were patients diagnosed with cancer and registered in the Nagasaki Cancer Registrybetween 1985 and 2004. For standardization, we calculated a Preference Index and five-year survival rate, andfor centralization we investigated Pareto curves and Gini coefficients as well as the annual average number ofcases per hospital. Results suggested that patients migrate to medical service areas different from where theyreside in order to receive treatment at facilities thought to have a better record of treatment. In addition, while thenumber of patients and treatment facilities for childhood cancer was decreasing due to a decline in the numberof children, the centralized tendency differed for the 12 diagnoses assessed. By conducting analyses based onpopulation-based cancer registries using the evaluation methods employed in this study, it should be possibleto investigate patients’ migrant patterns, as well as to develop systems for providing medical care in secondarymedical service areas.