Update from the President
Dr. Kunihiko Ishitani
President of The International Reserch Society of the SCPSC
President, Higashi Sapporo Hospital
Embracing the Active Role of Pathologists in Cancer Palliative Care
The Strength of Interdisciplinary Collaboration in Supporting Patients
A multidisciplinary team approach has long been advocated as a foundation for improving the quality of cancer care. In recent years, the importance of patient and public involvement in the medical decision-making process has been increasingly emphasized, marking a significant shift in healthcare toward "collaboration and autonomy."
Higashi Sapporo Hospital has a 42-year history as a medical institution specializing in cancer palliative care and has actively promoted comprehensive, multidisciplinary team-based care.¹)²) One particularly noteworthy initiative is the “Knowing the Disease Well” Outpatient Clinic, established in 2015. This innovative consultation model in which a pathologist engages in a direct dialogue with the patient was conceived and led by Dr. Noriyuki Sato, Vice Chair of the hospital and Director of the Pathology and Immunology Center, as well as Professor Emeritus at Sapporo Medical University. Dr. Sato also served as President of the 71st Annual Meeting of the Japanese Cancer Association in 2012 and of the 102nd Annual Meeting of the Japanese Society of Pathology in 2013.³)
A Decade of Dialogue-Based Pathologist Consultations
From May 2015 to March 2025, the “Knowing the Disease Well” Outpatient Clinic has provided free, one-on-one consultations (typically one hour each) once a week for cancer patients and their families (catering to 3 to 4 individuals per session).
The consultations have covered a wide range of topics, including:
1. Understanding the disease itself, including the diagnosis and pathological findings.
2. Clarifying the meaning and interpretation of test results.
3. Providing information on treatment plans and disease trajectory.
4. Addressing psychosocial issues such as fear of recurrence or metastasis, concerns about prognosis, and family-related matters.
▲Click to view enlarged image
Consultations were initiated either through referrals from attending physicians or nurses, or through direct requests from patients or their families.
Table1summarizes patient backgrounds, number of consultations, follow-up periods, and types of illnesses during the 10-year period. A qualitative analysis of the pathologists’ notes and patient feedback following the consultations identified three key inductive themes: “deepened understanding,” “emotional reassurance,” and “enhanced autonomy.” Many patients expressed feelings such as “I feel relieved,” “I now understand,” and “I feel more positive.” In numerous cases, patients who had appeared distressed at the beginning of the first session were smiling by the end.
Beyond pathological diagnosis: Pathologists pioneering new horizons in communication
A representative case
The patient was a woman in her 50s who experienced breast cancer with relatively stable postoperative course. Following the death of her sister and hospitalization of her father, she began to experience profound anxiety. Although she wished to live for the sake of her young daughter, she was overwhelmed by a sense of hopelessness about the future. During her consultation with the pathologist, her condition was explained in detail. The pathologist emphasized that understanding the nature of her illness was essential for future planning, and encouraged her not to blame herself and to trust in the potency of her immune system. After the session, she stated, “I feel relieved” and “I'm happy,” and reaffirmed her commitment to continue with intensive chemotherapy. She continues to attend follow-up consultations every six months.
This initiative represents a departure from the traditional physician–patient relationship. By engaging in a direct dialogue with each patient, the pathologist helps deepen their understanding of the essence of the illness that goes beyond test results and treatment plans. This, in turn, provides a foundation for informed decision-making, emotional reassurance, and a greater sense of autonomy.
As a new model of palliative care support that also addresses concerns often overlooked in routine clinical settings, it deserves greater attention and recognition.
The next frontier in palliative care
To date, patient–pathologist consultations have primarily focused on providing pathological diagnostic information, with very few initiatives explicitly aimed at supporting patient decision-making. While reports by Booth⁴) and Lapedis et al.⁵) are examples of such pioneering work, there are virtually no studies examining the role of pathologists in the context of palliative care. In this regard, the “Knowing the Disease Well” Outpatient Clinic stands out as a truly groundbreaking initiative one that connects the pathologist’s expertise with patient understanding and emotional support.
Going forward, evaluation research that incorporates objective outcomes such as patient satisfaction, understanding, and psychological stability will be essential.
Breathing new life into pathology
The “Knowing the Disease Well” Outpatient Clinic has demonstrated a new and evolving role or pathologists within a multidisciplinary care team. By clearly explaining pathological findings and responding with empathy to patient concerns and uncertainties, pathologists can serve as a vital bridge between diagnosis and understanding. The fulfilment of this role requires not only deep medical expertise but also advanced communication skills. Through direct engagement with patients, the pathologists’ words have the power to make medicine more humane. The involvement of pathologists in cancer palliative care not only expands the scope of interdisciplinary practice but also enriches the very heart of patient-centered medicine.
References
1. Terui K, Koike K, Hirayama Y, et al. Recent advance in palliative cancer care at a regional hospital in Japan. Am J Hosp Palliat Care. 2014;31(7):717–722.
2. Kusakabe T. Sapporo: history of a conference.
BMJ Support Palliative Care Blog 2023. https://blogs.bmj.com/spcare/2023/09/05/sapporo-history-of-a-conference/
https://blogs.bmj.com/spcare/2023/09/12/synopsis-of-a-conference-that-nearly-never-happened-the-2023-sapporo-conference-for-palliative-and-supportive-care-in-cancer-scpsc-in-japan/
3.Ogushi Y, Sato N, Kusakabe T. Pathologist-led support in palliative cancer care: A consultative approach to enhancing patient understanding, concerns, and autonomy. Am J Hosp Palliat Care Med. 2025.https://doi.org/10.1177/10499091251385972
4. Booth AL, Katz MS, Misialek MJ, et al. “Please help me see the dragon I am slaying”: implementation of a novel patient–pathologist consultation program and survey of patient experience. Arch Pathol Lab Med. 2019;143(7):852–858.
5. Lapedis CJ, Horowitz JK, Tolle LB, et al. The patient–pathologist consultation program: a mixed-method study of interest and motivation in cancer patients. Arch Pathol Lab Med. 2020;144(4):490–496.
Announcement: The 5th Sapporo Conference for Palliative and Supportive Care in Cancer
The deadline for general abstract submissions has been extended to
Friday, December 26, 2025, at 12:00 noon (JST).
We warmly welcome your submissions.
“Accepted excellent abstracts following the review process are scheduled to be published in BMJ Supportive & Palliative Care.”
Please click the image below to visit the official conference website.
👉 https://www.sapporoconference.com/
History
The Pioneers of Hospice and Palliative Care: A New Genealogy of Historical Consciousness
The past shapes the present, and the present is always in a state of transformation. From within this transformation, we may discern paths toward the future. Thus, the past must be constantly re-evaluated. Genealogy, in this sense, is a means of intervening in the present.
— Michel Foucault, The Archaeology of Knowledge
On September 25, 2025, Dr. Balfour Mount, who laid the foundations of modern palliative care in Canada and was widely known as “the father of modern palliative care,” passed away. We commemorate his remarkable legacy through a tribute contributed by Dr. Camilla Zimmermann, who has devoted her clinical and research career to palliative care in the same country. We are deeply grateful to Dr. Zimmermann for kindly sharing her warm reflections with us despite her many commitments.
Dr. Balfour Mount
Professor Camilla Zimmermann
(Senior Scientist, Princess Margaret Cancer Centre, Toronto, Canada / Head of the Division of Palliative Care, University Health Network, Toronto, Canada / Professor, University of Toronto, Canada)
Balfour Mount – In Memoriam
When I was asked a few months ago if I could write a piece about Dr. Balfour Mount for this Newsletter, I immediately said yes, but also felt the weight of portraying someone so important in our field. I wanted to be able to give enough time to the task, and grants and travel kept me from starting immediately. In the meantime, Dr. Mount has died, and the task of writing about this giant in the field of palliative care feels more daunting than ever.
I met Dr. Mount only a few times – not enough to call him Bal or even Balfour – but these few times were enough for him to have a profound influence on me and on my career. As medical students at McGill University in the late 80’s-early 90’s, we had only one lecture on palliative care in our first year. Although our class attendance was remarkably poor, the lecture hall was packed for the lecture by Dr. Mount. A combination of film, music, and narrative, his lecture was less a presentation of facts than a performance and dramatization. We were mesmerized as we listened with new ears to the lyrics of Pink Floyd’s “Time” from Dark Side of the Moon, and other songs of the 70’s, reflecting on how they represented our society’s avoidant attitude to death. I was so struck by this lecture that I vowed then and there, at this lecture in my first year of medical school, to become a palliative care physician. I also began volunteering at the Palliative Care Unit at the Royal Victoria Hospital, together with several classmates. And later as class president, I invited Dr. Mount to give the lecture for our “Link Formal”, the event that marked our transition from the classroom to clinical work in the hospital. Again, he left us – or at least me - inspired to be the kind of physician that he was. He also characteristically sent me a hand-made card after the event (not just hand-written but actually hand-drawn), thanking me for the invitation. I have kept it to this day.
Dr. Mount was one of the most charismatic and inspiring people I have ever met. Born in Ottawa, Ontario in 1939, he trained initially as a urologist at McGill and as a surgical oncologist at Memorial Sloan Kettering. While working as a surgeon at McGill, he became disillusioned with a medical system that focused on curing and undervalued caring. The turning point for him was attending a lecture by Dr. Elizabeth Kübler-Ross in 1972, in which she discussed her book On Death and Dying. Struck by her description of the inadequacies of care for the dying in North America, he decided to do a study in Montreal, documenting the end-of-life care of patients who were dying in hospital. He found that patients often suffered from uncontrolled pain and other symptoms, particularly at the end of life; psychological, social and spiritual needs were even less likely to be addressed. He concluded that a program was needed to address these unmet needs.
Inspired by continued conversations with Kübler-Ross, Dr. Mount contacted Dame Cicely Saunders, who founded the hospice movement, and travelled to St. Christopher’s Hospice to meet with her. This meeting catalyzed his long friendship with Cicely Saunders, and led to Dr. Mount opening a hospital-based palliative care service and palliative care unit at the Royal Victoria Hospital in 1975. The term “hospice”, however, had negative implications for French-speaking Canadians. For this reason, Dr. Mount coined the term “palliative care”, originating from the Latin “palliare” or “to cloak”. The program he founded grew and soon encompassed not only an inpatient unit, but also a consultation service, a home care program, an outpatient clinic, and a bereavement follow up program, as well as research and teaching – the world’s first comprehensive palliative care program. His hard work and vision eventually made him a leader in the birth of a clinical and academic field that has spread worldwide.
Dr. Mount is widely considered to be the “Father of Palliative Care”, not only because he coined the term and was a pioneer in the field, but also because he embodied what palliative care stood for in terms of whole-person care. He was someone who made everyone he spoke to feel important and valued and there are many lasting testaments to his work. He founded not only the palliative care unit that now bears his name, but also Palliative Care McGill, and the McGill Programs in Integrated Whole Person Care. He was the founding President of the Canadian Society of Palliative Medicine and served as the Eric M. Flanders Emeritus Professor in Palliative Care. He also co-founded the Biennial International Congress on Palliative Care in 1976, which continues to be held every second year in Montreal. He has received multiple awards and honours, including Officer of the Order of Canada, Officer of the Order of Quebec, and the Queen Elizabeth II Diamond Jubilee Medal. In 2018, I travelled to Hamilton for his induction into the Canadian Medical Hall of Fame.
Dr. Mount died on September 25, 2025 in the palliative care unit that he founded. He leaves us a legacy of the programs he created, the people he trained, mentored and inspired, and an entire clinical and academic field that grew from his work. He also has taught us to be proud of our field and to remember our purpose of treating not only the individual and their symptoms, but the whole person and their family – including their hopes, fears, dignity, and their humanity.
Though captured far from Canada,
this scene somehow evokes Dr. Balfour Mount's
gentle gaze and his richly colored life.
Thrilling News: A Joyous Announcement!
BMJ SPC Forum, in partnership with the International Research Society of the Sapporo Conference, Japan, co-publishes its seasonal Newsletter in the BMJ SPC Forum
August 12 , 2025. The Summer issue of the SCPSC Newsletter was published on the BMJSPCare Forum.
Member's News
Welcoming our latest addition to the Board Directors
Dr. Takuya Matsunaga
Clinical Professor, Sapporo Medical University School of Medicine
Director of the Hematology Department, Higashi Sapporo Hospital
Dr. Kunihiko Ishitani's Choice
Introducing recent studies highlighted by Dr. Kunihiko Ishitani.
【Notice】This section, previously titled “Topics,” has been renamed“Dr. Kunihiko Ishitani’s Choice” starting from this issue.
1, No health without peace
Academia Medicine 2025;2
doi.org/10.20935/AcadMed7637
2, Ending nuclear weapons, before they end us
Journal of the National Cancer Institute, 2025, 117(7), 1296–1298 https://doi.org/10.1093/jnci/djaf102
3, Epidemiological and demographic trends and projections in global health from 1970 to 2050: a descriptive analysis from the third Lancet Commission
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00902-X/
4, The evolution of serious health-related suffering from 1990 to 2021: an update to The Lancet Commission on global access to palliative care and pain relief
Lancet Glob Health 2025; 13(3): e422–436
DOI: 10.1016/S2214-109X(24)00476-5
(comment；The paradox of increasing serious health-related suffering Camilla Zimmermann )
5, Future care planning BMJ Supportive & Palliative Care. 2025;15:614-
https://spcare.bmj.com/content/15/5/614
6, Senescence as a therapeutic target in cancer and age-related diseasesNat Rev Drug Discov, 2025. 24(1):57-71
https://doi.org/10.1038/s41573-024-01074-4
7, Early identification of weight loss trajectories in advanced cancer andassociations with survivalJournal of the National Cancer Institute, 2025. 117(8),1729–1732
https://doi.org/10.1093/jnci/djaf030
8, Chronic opioid use and incident opioid use disorders in survivors of adolescent and young adult cancer after cancer treatment
Cancer,2025. 131, (10),e35866
https//doi.org/10.1002/cncr.35866
9, Cancer vaccines and the future of immunotherapy
Lancet 2025. 406,(10499) p189-202
DOI: 10.1016/S0140-6736(25)00553-7
10, Patient and carer experience of chimeric antigen receptor T-cell therapy: a multicentre qualitative study
BMJ Supportive & Palliative Care 2025;0:1–10.
https://doi.org/10.1136/spcare-2025-005371
Dr. Kunihiko Ishitani's Choice (continued)
11, Mapping of Children’s Palliative Care Development Globally in 2023 Children. 2025, 12(4), 440
https://doi.org/10.3390/children12040440
12, Early phase study enrollment in Canadian children with cancer near end of life: A retrospective cohort study from Cancer in Young People in Canada
Cancer,2025.131, (12), e35942
https://doi.org/10.1002/cncr.35942
13, Improving assessment of financial toxicity of cancer immunotherapySupportive Care in Cancer. 2025.33:735 https://doi.org/10.1007/s00520-025-09796-w
14, Financial Toxicity in Cancer Clinical Trials: An Issue in Need of Clarity and Solutions
Journal of Clinical Oncology, 2025.43,(20)
https://doi.org/10.1200/JCO-24-01577
15, Voluntary-assisted dying, euthanasia and physician-assisted suicide: globalperspectives-systematic reviewBMJ Supportive & Palliative Care 2025;15:423-435.
https://doi.org/10.1136/spcare-2024-005116
16, Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method studyBMJ Supportive & Palliative Care 2024;0:1–11.
https://doi.org/10.1136/spcare-2024-004946
17, Psychotherapy and counselling as a tool for promoting dignity in mental healthAcademia Mental Health and Well-Being, 2025.2;( 2)
https://www.doi.org/10.20935/MHealthWellB7636
18, Dignity, families, and family therapy Academia Mental Health and Well-Being. 2025.2 (2)
https://www.doi.org/10.20935/MHealthWellB7674
19, Navigating culture and religion in palliative care
BMJ Supportive & Palliative Care 2025.0:1–8.
https://doi.org/10.1136/spcare-2025-005613
20, Reimagining cancer care in the USA: advancing supportive oncology throughthe Cancer Moonshot ProgramBMJ Supportive & Palliative Care 2025;0:1-3.
https://spcare.bmj.com/content/early/2025/06/27/spcare-2025-005547
Overseas Experience Report
At the Center of Supportive Care — A Visit to the Levine Cancer Institute, Charlotte
SCPSC Newsletter Editor Yukie Ishitani
From June 30 to July 1, 2025, I had the privilege of accompanying Dr. Kunihiko Ishitani, President of the SCPSC, on a visit to the Levine Cancer Institute (LCI) in Charlotte, North Carolina,USA (https://atriumhealth.org/for-providers/declan-walsh). The city’s calm and refined atmosphere seemed to quietly foretell the meaningful encounters that awaited me.
Throughout my visit, I was graciously hosted by Dr. Declan Walsh, Chair of the Department of Supportive Oncology. Despite his busy schedule, he kindly arranged every detail of my itinerary, occasionally offering a gentle “Would you like some coffee?” — a gesture that reflected his quiet thoughtfulness and the qualities of a true gentleman.
I had the opportunity to learn from education faculty members and other multidisciplinary professionals about their daily practice and how patient-centered care is seamlessly integrated within and beyond the institution.
It was also a great honor to meet Dr. Mellar Davis, Chair of the Department of Palliative Medicine and a distinguished leader in the field. In addition, I was pleased to meet Dr. Armida Parala-Metz, Director of the Hospice and Palliative Medicine Fellowship Program.
Shared across the entire team were a calm demeanor and a deep sense of pride in their work. During one of the meetings, Dr. Ishitani introduced the upcoming 5th Sapporo Conference for Palliative and Supportive Care in Cancer (SCPSC) by sharing its flyer. When it was mentioned that Dr. Walsh would serve as chair for one of the most challenging sessions, everyone listened attentively, and a warm, genuine exchange naturally followed.
Between Dr. Walsh and Dr. Ishitani, I sensed mutual respect for each other’s vision and lifelong work — a quiet trust that emerged effortlessly. Though my stay was brief, witnessing the living values of collaboration, respect, and patient-centeredness left me deeply inspired and moved.
My heartfelt gratitude goes to Dr. Walsh and all members of LCI for their warmth and sincere hospitality. I would also like to take this opportunity to express my deep appreciation to the staff members who extended their thoughtful support throughout my visit.
References
1.York B, Self J, Walsh D. Supportive oncology development in a major metropolitan area: regional services. Support Care Cancer (2025) 33:536. https://doi.org/10.1007/s00520-025-09565-9
Exterior view of the Levine Cancer Institute (LCI)
Dr. Anthony Caprio, Vice Chair,Department of Supportive Oncology Section Chief, Medical Education and Dr. Kunihiko Ishitani share a thoughtful conversation on daily clinical practice
Announcement from the SCPSC Team
Autumn is deepening here in Sapporo, and preparations for the 5th SCPSC are steadily progressing with the full commitment of our team. We are pleased to inform you that the deadline for abstract submission has been extended to Friday, 26 December 2025, at 12:00 (JST).
We sincerely look forward to receiving your submissions.
We have already received many encouraging comments such as “The program looks outstanding.” With participants joining us from overseas, we are excited to see this conference grow into a truly international learning opportunity.
We hope you enjoy this issue of our Newsletter as well.
With warm regards, The SCPSC Team
