Sarcoma Strong Interview with Dr Katsuhiro Hayashi by Gokul Kalyanasundaram, 2nd year medical student at Albany Medical College, Albany, New York
- How are sarcoma patients cared for in Japan? What challenges do you and your orthopaedic oncology team currently face?
Orthopaedic surgeons in Japan are involved with the surgery and chemotherapy, and this is different from other countries in the world. As surgeons, we are not as familiar with the chemotherapy which makes it challenging. There are many choices for chemotherapeutic agents, and it is difficult to keep up with the updated chemotherapeutic agents. Also, unplanned excision of sarcoma can be problematic, especially when performed by non-orthopedic surgeons who excise the sarcoma without care. Another problem is that there are too many sarcoma and cancer centers in Japan. There are probably more than 50 centers that treat sarcoma patients, so each hospital only receives a limited number of osteosarcomas per year. If we wanted to do a clinical randomized trial, we would not have enough patients. Each hospital also has their own treatments and different versions of surgical procedures. Lastly, we cannot use allografts here in Japan because of religious reasons and because we do not have any bone banks. Therefore, we have developed new techniques that use recycled autologous bone.
- How is your team working to improve care for sarcoma patients in Japan?
Our focus is on improving surgical procedures using liquid nitrogen. Our research has helped some of our patients walk and run after osteosarcoma of the knee. We are also performing basic science research on cancer metastasis and regeneration research using adipose-derived stem cells.
- How is follow-up or surveillance care provided for sarcoma patients?
We follow up with our sarcoma patients in the outpatient clinic for ten years. Some pediatric patients may need longer follow up for twenty to thirty years because they may have problems later with pregnancy or secondary cancer.
- Are there any challenges with access to care for sarcoma patients?
Actually, it is not a big problem because there are almost too many hospitals in Japan. Sarcoma patients have many options for treatment in Japan.
- How many sarcoma patients does your institution care for each year? Who are the members of the orthopaedic oncology team at your institution?
Including soft tissue sarcoma, we care for probably 30 or 40 patients every year at my institution. In total, there are about 10 orthopaedic oncologists at my institution: one professor, five staff orthopaedic oncologists, and four residents training in orthopaedic oncology. We do not have any nurses or other staff specifically working with orthopaedic oncology.
- Where does your institution fit in with the larger Japanese orthopaedic oncology community? Are there any opportunities for collaboration?
Kanazawa university is a large center, and we collaborate with other cancer centers in Tokyo. We are involved in a prospective randomized multicenter trials with the Japanese Clinical Oncology Group and a retrospective orthopaedic oncology study with the Japanese Musculoskeletal Oncology Group.
- How did you hear about Sarcoma Strong and how did you recruit your team? What are your plans for the team next year?
Our chairman, Dr. Tsuchiya, knew Dr. DiCaprio, and he asked me to set up our Sarcoma Strong team. Next year, I hope that we can make a Sarcoma Strong Japan team. This year was the Kanazawa team, but I plan to ask other Japanese orthopaedic oncologists to make a Japanese team. Also, COVID-19 has made it difficult for the past two years since I could not ask patients to join the event. After the pandemic, we will be able to have a larger team.
Interview completed 8.26.2021