Author: Dr. Kunihiko Ishitani
President of The International Research Society of the Sapporo Conference for Palliative and Supportive Care in Cancer (SCPSC) President, Higashi Sapporo Hospital, Japan
Our Autumn 2025 newsletter is out and can be accessed here.
Embracing the Active Role of Pathologists in Cancer Palliative Care
There is much to be said for 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 Centre, 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.
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 ground-breaking 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-centred 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.
And here are the details of the 2026 Conference. Not long to go.
