Characteristics of sudden unexpected cancer deaths investigated by medical examiners in Tokyo, Japan (2009).
BACKGROUND
Annually, about 400 cases of sudden unexpected death are attributed to cancer in Tokyo, Japan. These individuals may have been undiagnosed, or their medical conditions may not have been carefully evaluated before death. We examined medical consultations, cancer diagnoses, and economic status of all cancer deaths investigated by medical examiners in 2009.


METHODS
Among cases handled by the Tokyo Medical Examiner's Office in 2009 (N = 12 493), records for all cases of cancer death (n = 400) were reviewed to determine the extent of medical care provided, diagnosis before death, and economic status of the decedent.


RESULTS
Most of the decedents (n = 232; 58%) had received a diagnosis of terminal/advanced cancer during a medical consultation. Most did not receive such medical consultations at home, despite their very weak physical condition. However, nearly one quarter of decedents (24%; 95/400) had not received a cancer diagnosis before death. The proportions of decedents who had been indigent, received no medical consulting, and had colon cancer were significantly higher among undiagnosed cases than among diagnosed cases. Indigent persons were the largest subgroup (n = 19; 43%) among those who had never received a medical consultation (n = 44). In addition, the proportion of those who had discontinued or received no medical consultation was higher among indigent persons than among non-indigent persons.


CONCLUSIONS
The quality of medical services for cancer patients could be improved by educating general practitioners about terminal care, expanding efforts to monitor and diagnose cancer, especially among indigent patients, and increasing participation rates for colorectal cancer screening.
Tokyo Medical Examiner's Office, Tokyo Metropolitan Government.
Hideto
H
Suzuki
Takanobu
T
Tanifuji
Nobuyuki
N
Abe
Tatsushige
T
Fukunaga
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003334:Coroners and Medical Examiners; D003644:Death Certificates; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D012923:Social Class; D013727:Terminal Care; D014041:Tokyo / Q000453:epidemiology; D055815:Young Adult