Abstract
Dear Editor:
The hospice care unit of Tsuboi Hospital (Fukushima, Japan) established in 1990 is located about 80 km from the Fukushima Daiichi Nuclear Power Plant (FDNPP). On March 12, 2011, in the aftermath of Great East Japan Earthquake, residents of 13 municipalities, who were about 20–30 km away from FDNPP, were evacuated by the government.
In 2012, 164,865 evacuees were recorded in Fukushima prefecture.
Nuclear disasters highlight the importance of issues related not only to radiation, but also evacuation and deterred restoration processes. 1 Severe psychological distress was highly prevalent among those living in evacuation and those who experienced loss of someone close. 2 The local government certified disaster-related deaths as well, which were characterized as indirect death resulting from poor health and exhaustion during evacuation. The number of disaster-related deaths in Fukushima was 2286 on September 2019, in contrast to 1614 direct deaths in 2011. 3
Except for a few case reports, there is no accurate data on those who suffered life-limiting malignant illness during evacuation. The primary settings of end-of-life care have recently shifted to hospice centers and patient's residences according to their values and preferences. 4 Evacuees from the nuclear accident, however, were not able to opt for residential care for many years owing to high levels of radiation exposure.
Forty-two evacuated patients were admitted to our hospice for nine years, the average age was 80.1 years, and length of stay on average was 50 days. Of them 21 (50%) suffered from cancer of digestive organs, 12 (29%) from lung cancer, and 9 (21%) had other malignancies. The number of patients declined gradually after peaking in 2012, and it increased again in 2017 (Fig. 1). It is suggested that the alerts around our hospice began to be lifted in 2014, and patients gradually returned home, reducing the number of hospitalizations; but the fact that the number of hospice patients did not decline completely indicated a low return rate at the region nearer FDNPP.
Annual changes of the number of patients in our hospice and evacuees in Fukushima prefecture.
Even for staff members with years of experiences in hospice, it was difficult to cope with the patients who needed terminal care as they developed a deep sadness about losing their hometown. Although public funding for them was secured, their psychological suffering continued to increase. It may be necessary for health care providers in disaster areas to intervene in patients' social circumstances beyond the mere provision of medical services. 4 The patients seemed to have a feeling of despondency at first, coupled with a feeling of absurdity of being evacuated, and suffering through the sickness. We need to recognize the grief that elderly people, who had been rooted in the community for several generations, suffered as they died without returning to their home.