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The variation in survival rates among patients with cancer based on residential areas has become a significant concern globally. In conclusion, the introduction of the BPPCCP in may have reduced regional variation in the survival rate of patients with cancer in Osaka Prefecture. Cancer survival rates are known to differ not only between countries 1 but also within regions of the same country.
For example, regional variations in survival rates have been reported for hepatocellular carcinoma in England 2 and colorectal cancer in Ontario, Canada 3. In Japan, significant regional variations are observed in age-adjusted mortality rates for individuals under 75 years, ranging from These variations underscore the ongoing challenge of achieving equitable cancer care. To address regional variation in cancer survival, various countries have implemented policy measures.
However, evidence on the effectiveness of these measures remains mixed 6. For example, in Norway, centralization measures did not significantly reduce regional variations in survival rates 7 , whereas in Finland, improvements in primary care appear to have narrowed these variations 8. Conversely, decentralization measures in Canada may have associated with increased variations in survival rates for certain cancer types, such as central nervous system tumors 9.
In accordance with the Basic Plan to Promote Cancer Control Programs BPPCCP introduced in 10 , each prefecture has developed and implemented its own cancer control plan every 5—6 years, aimed at ensuring equitable access to medical facilities regardless of their residential areas CMAs are defined under the Medical Care Act to provide efficient inpatient cancer treatment and are determined based on factors such as population demographics, hospital bed capacity, geographic conditions, and transportation accessibility 12 , Osaka, for example, has eight CMAs DCCHs must meet specific criteria, including minimum physician staffing, surgical volume, and the availability of cancer consultation support services This hybrid system of decentralization and centralization aims to balance resource concentration in specialized facilities with regional accessibility, creating a unique model of cancer care.
